Author + information
- Evan L. Hardegree,
- Erica J. Fidone,
- Justin Price and
- Mark Lawrence
Kounis Syndrome is an acute coronary event resulting from an allergic trigger, ranging from vasospastic angina to acute myocardial infarction. Treatment strategies must target not only the acute coronary syndrome (ACS), but also the underlying allergic reaction. Due to the risk of coronary spasm, use of epinephrine is controversial.
A 61 year-old man presented to the emergency department after being swarmed by bees. He complained of diffuse pain, but denied cardiopulmonary symptoms. His medical history included hyperlipidemia, type 2 diabetes, emphysema, and non-ischemic cardiomyopathy due to substance abuse (ejection fraction 20%). Physical exam was significant for tachycardia, extensive envenomation and urticaria. Initial electrocardiogram (ECG) revealed no evidence of active ischemia.
For concern of impending anaphylaxis, he was treated with epinephrine, corticosteroids, and antihistamines. Two hours later, he developed chest pain, dyspnea and diaphoresis. Repeat ECG revealed ST elevation in leads II, III, and aVF with reciprocal changes. He received aspirin and heparin and was taken for coronary angiography. He had 80% occlusion of the right coronary artery by thrombus, treated with aspiration thrombectomy and stent placement, as well as occlusion of the distal right posterior descending artery. Surprisingly, there was also extensive thrombus throughout the left coronary tree involving the left main, left anterior descending (LAD), and first diagonal coronary arteries. He underwent thrombectomy of these sites, with stenting of the mid-LAD. Post-procedurally he was treated with dual-antiplatelet therapy in addition to a steroid burst and antihistamines. He was ultimately released from the hospital five days later.
This case demonstrates the importance of early recognition and appropriate treatment of Kounis syndrome and its subsequent sequelae. The decision to use epinephrine should be made with utmost caution and close monitoring, and when required, sulfite-free epinephrine should be chosen. In addition to treatment of ACS, attention must also be given to treatment of the underlying allergic process.
Moderated Poster Contributions
Pulmonary Hypertension and FIT Clinical Decision Making Moderated Poster Theater, Poster Hall B1
Saturday, March 14, 2015, 11:15 a.m.-11:25 a.m.
Session Title: FIT Clinical Decision Making: Moderated Poster Session I
Abstract Category: Acute Coronary Syndromes
Presentation Number: 1127M-13
- 2015 American College of Cardiology Foundation