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Selective Intracoronary Injection of Nitrates Was Effective for Contrast Media-induced Type I Kounis Syndrome After

Tasuku Kurokawa1, Aoi Takahata1, Tadateru Iwayama1

  • 1Department of Cardiology, Okitama Public General Hospital, Japan.

Internal Medicine (Tokyo, Japan)
|March 30, 2025
PubMed

A 77-year-old man presented for computed tomography (CT) with iodinated contrast for follow-up of gastric cancer. After contrast injection, the patient experienced cardiac arrest. A post-return spontaneous circulation electrocardiogram showed ST segment elevation in the inferior leads and V1-3. Since type I Kounis syndrome (KS) was suspected, corticosteroids and antihistamines were administered intravenously. Subsequently, coronary angiography (CAG) revealed coronary spasms, and selective intracoronary injection of nitrates successfully resolved each spasm. Strategic substitution of contrast media did not induce any additional allergic reactions. The optimal timing and preferred strategies for performing CAG in patients with KS were also discussed.

Keywords:
contrast medianitratestype I Kounis syndrome

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