Kounis Syndrome Presenting as Coronary Artery Spasm

Kounis syndrome
Figure 1. Electrocardiogram recorded during angina episode at the rural hospital. Sinus rhythm, D1, D2, aVF, V4, V5, V6 leads had elevated ST segments.

Kounis Syndrome

In this case, a 38-year-old guy with diarrhoea was checked into a local hospital. Three days prior to admission, he experienced stomach pain, dizziness, and diarrhoea with blood stains after eating raw foods. After receiving an infectious diarrhoea diagnosis, he was hospitalised. He has never before experienced an adverse reaction to any medications, foods, or environmental factors. He experienced chest pain, dyspnea, and hypotension the following morning at the hospital immediately after receiving the paracetamol infusion. Urticaria and angioedema were not present, according to the records. Additionally, paracetamol was administered to him for the first time since his admittance at this point. Other examinations were uneventful.

In addition, figure 1 shows the ECG (recorded in the rural hospital), which showed no q waves but anterolateral and posterior ST elevation and depressed ST segments in leads aVR, V1, V2, V3, and V4R. An elevated level of hs-Troponin T of 1580 ng/L (reference range: 24.9 ng/L) was found in the blood sample. At the time of admission, neither the baseline ECG nor troponin concentration was recorded. Following the diagnosis of acute myocardial infarction, the patient was sent to a nearby secondary hospital.

Six hours after the angina attack, the patient underwent a second ECG, which showed sinus rhythm, no ST-T changes, and no q waves at any of the leads. Blood levels of hs-Troponin T and D-dimer were 2716 ng/L (reference range: 14.0 ng/L) and 5.21 mcg/mL (reference range: 0.5 mcg/mL), respectively, at that time. He said that he experienced no chest pain, no breathing difficulties, and normal vital signs. Once Kounis syndrome was identified, he was sent to another cardiology facility with a catheterization lab. He was admitted to the hospital for a planned coronary angiography and came to the hospital more than 12 hours after the angina episode.

Source: American Journal of Case Reports

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.


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