Coronary Artery Spasm as a Frequent Cause of Acute Coronary Syndrome

Kounis syndrome or allergic myocardial infarction is an acute coronary syndrome in the course of an allergic reaction. In allergic patients in response to a specific condition - nourishment, inhalation, environmental substances, drug or insect bite there is an allergic reaction involving many different cells and mediators that can cause coronary artery spasm or initiate the process of rupture and activation of atherosclerotic plaque resulting in acute coronary syndrome. The paper describes a case of a young man with allergy to pollen and confirmed sensitization to nuts, who developed a full-blown anaphylactic shock after eating the nut mix and experienced a rapidly passing acute coronary syndrome with troponin up to 4.7 μg/L. An increased concentration of tryptase (15 μg/L), total IgE (> 3,000 IU/mL) and specific anti-nut IgE (55.1 kUA/L) were found. Based on the course of the disease and the results of allergic and cardiac tests, allergic type 1 myocardial infarction, i.e. caused by coronary artery spasm, was diagnosed. During the hospitalization, the patient’s condition improved quickly and after a few days he left the hospital without the signs of permanent damage to the heart muscle.

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Rapid Progression of Coronary Atherosclerosis by Coronary Artery Spasm Leading to Acute Coronary Syndrome

Circulation ◽

10.1161/circulationaha.108.839522 ◽

2009 ◽

Vol 119 (16) ◽

pp. 2233-2234 ◽

Cited By ~ 4

Author(s):

Ichiro Sakamoto ◽

Masahiro Mohri ◽

Hideo Yamamoto

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Coronary Atherosclerosis ◽

Coronary Artery Spasm ◽

Rapid Progression ◽

Coronary Syndrome

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P6005Incidence and clinical characteristics of coronary artery spasm in patients with out-of-hospital cardiac arrest

European Heart Journal ◽

10.1093/eurheartj/ehz746.0725 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

G Kawamura ◽

H Okayama ◽

S Kido ◽

T Aono ◽

K Matsuda ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Cardiac Arrest ◽

Heart Disease ◽

Coronary Artery ◽

Coronary Artery Spasm ◽

Coronary Spasm ◽

Coronary Syndrome ◽

Organic Heart Disease ◽

Japanese Guideline ◽

Hospital Cardiac Arrest

Abstract Background Substantial cases of out-of-hospital cardiac arrest (OHCA) due to acute coronary syndrome have been recognized thus far, but there have been few reports about the aetiology of patients with OHCA without the organic heart disease. Especially, coronary artery spasm would be one of the causes of OHCA. Purpose This study aimed to investigate causes of OHCA without the organic heart disease and to investigate the characteristics and angiographic findings of OHCA patients with vasospastic angina (VSA). Methods Between January 2010 and April 2018, 920 patients with OHCA caused by probable or definite cardiovascular disease were transferred to our hospital. Return of spontaneous contraction was successfully achieved in 151 patients, among whom diagnosis was made in 130 patients. First, we analysed the causes of OHCA in these patients. Second, we compared clinical and angiographic characteristics between the VSA group with OHCA (OHCA-VSA) and the VSA group without OHCA (stable VSA; n=72) from our database. Results Among the 130 patients, 95 (73%) had the organic heart disease; 72, acute coronary syndrome; 19, myocardial disease; 2, valvular heart disease; and 1, congenital heart disease. There were 35 patients (27%) without the organic heart disease. Nineteen patients had primary (i.e., Brugada syndrome, QT prolongation) or secondary arrhythmia (i.e. drug adverse effect). Electrocardiogram, coronary angiogram, and LV structure and function were normal in 35 patients. However, there were 16 patients (11%) with VSA defined by Japanese guideline. The OHCA-VSA group was significantly younger (50±14) than the stable VSA group (64±11, P=0.003). The incidence of diffuse-type spasm in the OHCA-VSA group (100%) was significantly higher than that in the stable VSA group (100% vs. 69%, P<0.05). In addition, the incidence of triple-vessel coronary spasm in the OHCA-VSA group was significantly higher than that in the stable VSA group (86% vs. 25%, P=0.003). Conclusion OHCA patients without the organic heart disease had considerable cases of VSA, in addition to primary or secondary arrhythmia. Furthermore, the severity of spasm in the OHCA-VSA group was more serious and extensive than in comparison with the stable VSA group.

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Recurrent acute coronary syndrome due to coronary artery spasm in different coronary arteries

Journal of Cardiology Cases ◽

10.1016/j.jccase.2013.05.007 ◽

2013 ◽

Vol 8 (3) ◽

pp. 95-98

Author(s):

Saman Rasoul ◽

Jan-Henk E. Dambrink

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Coronary Arteries ◽

Coronary Artery Spasm ◽

Coronary Syndrome

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Coronary Artery Spasm-Related Acute Coronary Syndrome in Patients With Coexisting Spasm of Angiographically Normal Coronary Artery and Fixed Narrowing of the Remaining Vessels

Angiology ◽

10.1177/0003319707300350 ◽

2007 ◽

Vol 58 (2) ◽

pp. 156-160 ◽

Cited By ~ 4

Author(s):

Ning-I Yang ◽

Ming-Jui Hung ◽

Wen-Jin Cherng

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Coronary Artery Spasm ◽

Normal Coronary Artery ◽

Coronary Syndrome

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Diclofenac Potassium-Induced Anaphylaxis with an Allergic Acute Coronary Syndrome and Premature Ventricular Contractions; Outpatient Clinic Management; A Case Report

10.37179/rijccm.000005 ◽

2020 ◽

Vol 01 (01) ◽

pp. 0013-0016

Author(s):

Yasser Mohammed Hassanain Elsayed

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Outpatient Clinic ◽

Anaphylactic Shock ◽

Heart Diseases ◽

Coronary Artery Spasm ◽

Type I ◽

Drug Induced ◽

Premature Ventricular Contractions ◽

Coronary Syndrome

Drug-induced disease is a common clinical entity. Drug-inducing anaphylaxis is a serious adverse effect. Several cases of allergic acute coronary syndrome or Kounis syndrome were reported. Premature ventricular contractions are the most frequent cardiac arrhythmia with or without structural heart diseases. A premature ventricular contraction is a sign of decreased oxygenation to the myocardium and anxiety but is also found in a healthy heart. A middle-aged married male patient presented to the physician outpatient clinic with syncope within one hour after ingested one tablet of diclofenac potassium (50mg). Diclofenac potassium-induced anaphylaxis and Kounis type I syndrome with premature ventricular contractions. Electrocardiography, oxygenation, monitoring for vital signs, and echocardiography were the done interventions. The dramatic disappearance of anaphylactic shock, Kounis type I syndrome, coronary artery spasm, and premature ventricular contractions after the traditional treatment of anaphylaxis had happened. Complete clinical and electrocardiographic recovery had achieved. The identi􀏐ication of drug-induced disease is a pivotal step in the diagnosis decision making of any medical problems. Diclofenac potassium can induce anaphylactic shock, Kounis type I syndrome, coronary artery spasm, and premature ventricular contractions. Kounis type I syndrome, coronary artery spasm, and premature ventricular contractions can be reversed with treatment of the cause without using anti-ischemic or ant-arrhythmic measures. Reassurance was the recommended regards diclofenac potassium-induced both coronary artery spasm and premature ventricular contractions that accompanied by anaphylaxis.

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