title: Acute myocardial infarction in a patient with hypofibrinogenemia: a case report.
abstract: BACKGROUND
  Congenital fibrinogen deficiency is a rare coagulation disorder usually responsible for hemorrhagic diathesis. However, it can be associated with thrombosis and there have been limited reports of arterial thrombotic complications in these patients.
  
  
  METHODS
  A 42-year-old Tunisian man with congenital hypofibrinogenemia and no cardiovascular risk factors presented with new onset prolonged angina pectoris. An electrocardiogram showed features of inferior acute myocardial infarction. His troponin levels had reached 17 ng/L. Laboratory findings confirmed hypofibrinogenemia and ruled out thrombophilia. Echocardiography was not useful in providing diagnostic elements but did show preserved left ventricular function. Coronary angiography was not performed and our patient did not receive any anticoagulant treatment due to the major risk of bleeding. Magnetic resonance imaging confirmed myocardial necrosis. Our patient was managed with aspirin, a beta-blocker, an angiotensin-converting enzyme inhibitor and statin medication. The treatment was well tolerated and no ischemic recurrence was detected.
  
  
  CONCLUSIONS
  Although coronary thrombosis is a rare event in patients with fibrinogen deficiency, this condition is of major interest in view of the difficulties observed in managing these patients.
authors.affiliation: Service of Cardiology, Rabta University Hospital, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia. fathiazghal@yahoo.com.
authors.forename: Fathia
authors.initials: F
authors.lastname: Mghaieth
authors.forename: Habiba
authors.initials: H
authors.lastname: Mizouni
authors.forename: Sihem
authors.initials: S
authors.lastname: Mbarki
authors.forename: Jihen
authors.initials: J
authors.lastname: Ayari
authors.forename: Ramy
authors.initials: R
authors.lastname: Trabelsi
authors.forename: Nidhal Ben
authors.initials: NB
authors.lastname: Moussa
authors.forename: Mohamed Sami
authors.initials: MS
authors.lastname: Mourali
authors.forename: Emna
authors.initials: E
authors.lastname: Mnif
authors.forename: Rachid
authors.initials: R
authors.lastname: Mechmeche