The concurrence of anginal pain in conditions associated with mast-cell and platelet activation involving interrelated and interacting inflammatory cells in the setting of allergic or hypersensitivity and anaphylactic is known as Kounis syndrome. It is noted that degranulation of mast cells releases inflammatory mediators which causing coronary vasoconstriction and tissue factor expression and consequently activates platelets.
A 70-year-old female patient, with no known medical illness, presented to our Emergency Department with complaint of pre-syncopal attack. Prior to that she claimed to have eaten 2 egg tarts and developed an allergic reaction. On her physical examination, she was only noted to have resolving generalised urticarial rashes. Her ECG showed T wave inversion on anterior leads with significant raised of troponin enzyme. Hence, she was diagnosed as non-ST elevation myocardial infarction with allergic reaction. She was admitted to the ward and proceed with coronary angiogram on the next day. Coronary angiogram result showed normal coronary artery. Subsequently, she was discharged well later.
Discussion & Conclusion
There are three variants of Kounis syndrome have been described, in this type of case is classified as type I. Type I variant includes normal or nearly normal coronary arteries without risk factors for coronary artery disease and with the acute release of inflammatory mediators that may induce either coronary artery spasm with can lead to acute myocardial infarction with raised cardiac enzymes and troponins. Managing kounis syndrome is challenging as the need to address both issues heart and allergic symptoms. The medication use can both worsen the allergy or worsen the heart condition.
allergic reaction, myocardial infarction, kounis syndrome, anaphylaxis