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population [ 1 , 2 , 3 , 4 ]. The emerging prevalence of cardiovascular disease in older PWH is reflected by the numerous case studies reported in recent years [ 5 ]. Management of myocardial infarction in a person living with severe haemophilia presents a particular challenge as treatment options often include antiplatelet therapy, anti-coagulation and invasive procedures. Here, we present the case of a middle-aged male with severe haemophilia A on extended half-life clotting factor prophylaxis, with an acute ST elevation myocardial infarction (STEMI) requiring

References [1] Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nichols M. Cardiovascular disease in Europe: epidemiological update 2016. Eur Hear J 2016;37:3232–45. [2] Herrick JB. Clinical features of sudden obstruction of the coronary arteries. JAMA 1912;LIX:2015–22. [3] Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). Eur Hear J 2019;40:237–69. [4] Chhapra DA, Mahajan SK, Thorat ST. A study of the clinical profile of right ventricular infarction in context to

References 1. Ginghina, C.. (2010). Tratat de cardiologie. Editura Academiei Romane. 2. Bertrand, M.E., Simons, M.L. & Walentin, L.C. (2002). Management of acute coronary syndromes in young patients. European Heart Journal 23 , 1809–1840 3. Antman, E., Bassand, J., Klein, W. & al.(2000).-Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction: The Joint European Society of Cardiology/American College of Cardiology Committee. J Am

References 1. Backus BE, Six AJ, Kelder JC, et al. Chest pain in the emergency room: a multicenter validation of the HEART Score. Crit Pathw Cardiol 2010;9:164-9. 2. Tofighiyan T, Rad M, Heydari A. Comparison of signs and symptoms Presentation in mens and womens with myocardial infarction in Mashhad hospitals. Med Surg Nurs J 2012; 1 (1) :26-30 3. Tofighiyan T, Rad M, Taghizadeh A, Rakhshani MH; Prevalence of Cardiac Arrhythmia Disorders in Patients with Myocardial Infarction Admitted to CCU Ward in the Vasei Hospital

References Jaffe AS, Miller W L. Acute Myocardial Infarction. In: Crawford MH, editor. Current diagnosis and treatment in cardiology. 2nd ed., New York: Lange Medical Books/McGrow-Hill; 2003. p. 57-87. Rosengren A, Hawken S, Qunpuu S, Sliwa S. Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study. Lancet 2004;364(9439):953-63. Hammar N, Alfredson L, Theorell T. Job characteristics and the incidence of myocardial infarction. Int J

, Bates E, et al. Cardiogenic shock caused by right ventricular infarction. A report from the SHOCK registry. J Am Coll Cardiol. 2003;41:1273-9. 4. Reynolds HR, Hochman JS. Cardiogenic Shock: Current Concepts and Improving Outcomes. Circulation. 2008;117:686-97. 5. Tchantchaleishcili V, Schubmehl H, Swartz MF, Hallinan W, Massey HT. Evolving strategies in the treatment of acutemyocardial infarction-induced cardiogenic schock. Am Cardiothorac Surg. 2014;3:606-11. 6. Hochman JS, Sleeper LA, Webb JG, et al. Early revascularization in acute myocardial infarction complicated

References [1] Roger VL. Epidemiology of myocardial infarction. Med Clin North Am 2007;91(4):537–ix. [2] Thompson DR, Lewin, R. J. P. Coronary disease: management of the post-myocardial infarction patient: rehabilitation and cardiac neurosis. Heart 2000;84(1):101–5. [3] Abu-Assi E, López-López A, González-Salvado V, Redondo-Diéguez A, Peña-Gil C, Bouzas-Cruz N, et al. The risk of cardiovascular events after an acute coronary event remains high, especially during the first year, despite revascularization. Rev Esp Cardiol Engl Ed 2016;69(1):11–8. [4] Simpson E

Bibliography 1. Rajeev Bhardwaj, Arvind Kandoria, Rajesh Sharma. Myocardial infarction in young adults-risk factors and pattern of coronary artery involvement. Niger Med J. 2014 Jan-Feb; 55(1): 44–47 2. Osula S, Bell GM, Hornung RS. Acute myocardial infarction in young adults: causes and management. Postgraduate Medical Journal 2002;78:27-30. 3. Ge J, Li J, Yu H, An Y. Acute myocardial infarction in young adults: Risk factors, clinical features, and management strategies. Cardiol Plus 2017;2:21-5 4. Choudhury, Lubna et al. Myocardial infarction in young patients

in the 21st century. Int J Cardiol. 2013;167:1807-1824. doi: 10.1016/j.ijcard.2012.12.093. 4. Oldgren J, Healey JS, Ezekowitz M, et al. RE-LY Atrial Fibrillation Registry Investigators. Variations in cause and management of atrial fibrillation in a prospective registry of 15,400 emergency department patients in 46 countries: the RE-LY Atrial Fibrillation Registry. Circulation. 2014;129:1568-1576. doi: 10.1161/CIRCULATIONAHA.113.005451. 5. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients

REFERENCES 1. Fournier JA, Cabezon S, Cayuela A, Ballesteros SM, Cortacero JA, Diaz De La Llera LS. Long-term prognosis of patients having acute myocardial infarction when ≤40 years of age. Am J Cardiol. 2004;94:989-992. doi: 10.1016/j.amjcard.2004.06.051. 2. Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10