J Cardiovasc Interv.  2024 Oct;3(4):227-232. 10.54912/jci.2024.0010.

Acute Coronary Syndrome Associated With Allergic Reaction: Kounis Syndrome

• Seung J
• Choo EH

• KMID: 2561222
• DOI: http://doi.org/10.54912/jci.2024.0010

Abstract

Acute coronary syndrome (ACS) is a spectrum of diseases that include patients with recent changes in clinical symptoms, with or without changes on electrocardiogram (ECG) or cardiac troponin concentrations. The most common cause of ACS is a plaque disruption in coronary arteries but here we present a case of ACS caused by hypersensitivity of a specific drug called rocuronium, which is a neuromuscular blocking agent used in induction of general anesthesia. A 64-year-old female experienced recurrent hypotension with ECG changes, and troponin level elevation during the general anesthesia. Coronary angiography showed intermediate lesions in the mid-left circumflex artery and posterior descending artery, and the spasm test showed equivocal results. Considering the possibility of anaphylaxis caused by the drugs used for general anesthesia, a skin prick test was performed, and a positive result was obtained from rocuronium. We found that allergic reactions to rocuronium had led to hypotension, ECG changes, and cardiac marker elevation. The occurrence of ACS due to allergic reactions is called Kounis syndrome (KS), and in this case, KS could be diagnosed. KS could be underdiagnosed in the clinical setting, so when a patient with ACS also has allergic components, we should suspect KS and simultaneously manage both cardiac and allergic components.

Keyword

Kounis syndrome; Acute coronary syndrome; Hypersensitivity; Rocuronium