Acute Coronary Syndrome in Patient with Viral Hepatitis C: An Underdiagnosed Condition in Sub-Saharan Africa

Abstract

Viral hepatitis C (VHC) infection is associated with many systemic diseases. Amongst these, the association with ischemic heart disease is underdiagnosed in Sub-Saharan Africa context. We present a case of acute coronary syndrome in a Cameroonian patient with viral hepatitis C with low cardiovascular risk. A 75 years old female followed up for hepatocellular carcinoma secondary to VHC cirrhosis. She was admitted in the hospital for a sudden, resting, intense constrictive thoracic pain lasting more than one hour. This patient initially consulted the gastroenterologist, but secondarily the cardiologist 24 hours after the previous consultation. The initial workup showed ST segment elevation in lead V1 to V4 with Q Wave in the same territory and elevated value of Troponin I us and CPKMB. Cardiac ultrasonography found akinesia in the anteroseptal and apical segments. Other biological exams showed a dyslipidemia without other cardiovascular risk factors. Despite poor financial resources, the patient was managed with Enoxaparine 8000 UI/12H, Clopidogrel 75mg/24H, Aspirine 100mg/24h. Rosuvastatine 10Mg/24h, Ramipril 2,5mg/24h and Nebivolol 2.5mg/24h, tramadol 100mg/8h, trimetazidine 35mg/12h, omeprazole 40mg/24h, molsidomine 1mg/8h. The pain disappeared 24hours after the beginning of the treatment. In sub-Saharan Africa with high burden of viral hepatitis C infection, we should consider this possibility in patients who present ischemic heart disease with lowcardiovascular risk.