Acute Coronary Syndrome Secondary to Kounis Syndrome: A Rare Presentation
Document Type
Article
Abstract
Background: Kounis syndrome is a rare cause of acute coronary syndrome. It is triggered by an allergic reaction with the main pathophysiological mechanism thought to be vasospasm of the coronary arteries. We present a case of a 40-year-old male who presented with Kounis syndrome after an allergic reaction to sunflower seeds.
Case: A 40-year-old male presented to the emergency department after exposure to sunflower seeds secondary to shortness of breath, rash, itchy throat, and chest pain. An EKG obtained in the emergency department showed hyperacute T waves then developing into ST elevation in the anteroseptal and lateral leads. After receiving epinephrine, methylprednisolone, famotidine, ticagrelor, aspirin, and heparin the patient was transferred to a cath-capable campus. On presentation, the patient's chest pain had resolved, repeat EKG showed resolution of ST elevations, and urgent cardiac catheterization was deferred. Cardiac catheterization was later performed which showed no evidence of angiographic coronary artery disease. The cause of ST elevation was thought to be secondary to Kounis syndrome.
Decision-making: ST-elevation myocardial infarction requires urgent therapy to decrease morbidity and mortality. Our patient presented with ST-elevation in a coronary distribution - thus urgent cardiac catheterization was initially indicated. However, with resolution of ST elevation and chest pain - the decision was made to delay coronary angiography in a patient who was experiencing a potentially lifethreatening allergic reaction. Kounis syndrome represents a rare etiology of ACS and knowledge of this entity can help guide clinicians in the management of these critically ill patients.
Conclusion: We report a case of ST elevation post allergic reaction in a patient in the absence of angiographic coronary artery disease - representing a rare case of Kounis syndrome.
First Page
3325
DOI
10.1016/S0735-1097(24)05315-4
Publication Date
4-2024
Recommended Citation
Roma N, Singh S, Roll M, Haque O, Desai S, Krinock M, Durkin M, Sheikh T. ACUTE CORONARY SYNDROME SECONDARY TO KOUNIS SYNDROME: A RARE PRESENTATION. Journal of the American College of Cardiology. 2024 Apr 2;83(13_Supplement):3325-.