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Published on: August 18, 2016
Type 1 Kounis Syndrome Presenting as Coronary Pseudostenosis During Status Asthmaticus
Allen M Yu1, Billal Mohmand1, Anita Z Li1
1Division of Cardiovascular Diseases, Department of Internal Medicine, Banner University Medical Center Phoenix, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA.
Background:
Kounis syndrome is an allergic acute coronary syndrome that may produce multivessel coronary vasospasm, angiographically mimicking obstructive coronary artery disease without atherosclerosis.
Case Summary:
A 46-year-old atopic man admitted for status asthmaticus developed inferior ST-segment elevation myocardial infarction, complete heart block, ventricular fibrillation, and cardiogenic shock on hospital day 3. Emergent angiography revealed multivessel vasospasm with apparent stenoses up to 90%. Cardiac magnetic resonance showed ischemic injury without myocarditis. Repeat angiography on hospital day 20 demonstrated nonobstructive coronary artery disease, supporting vasospasm-mediated coronary pseudostenosis.
Discussion:
Severe status asthmaticus may precipitate type 1 Kounis syndrome. Apparent coronary stenoses during active vasospasm may represent vasospasm-mediated pseudostenosis and should be reassessed before revascularization is considered.
Take-Home Messages:
Severe status asthmaticus may precipitate type 1 Kounis syndrome with ST-segment elevation myocardial infarction, malignant arrhythmias, and cardiogenic shock despite nonobstructive coronary arteries. Apparent coronary stenoses during active vasospasm may represent vasospasm-mediated pseudostenosis and should be reassessed before revascularization is pursued.
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