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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 2, March 2013
AFRICA
e11
This concept of ‘the coincidental occurrence of chest pain
and allergic reactions accompanied by clinical and laboratory
findings of angina pectoris’ was first described in 1991 and is
known as the Kounis syndrome.
1
On recognition of this clinical entity, a number of hypotheses
have been proposed to explain the causal relationship between
allergic reactions and acute coronary syndromes. Of these, a
mast cell-driven vasospastic and inflammatory response acting
on the coronary endothelium has gained acceptance as the main
causative mechanism.
Mast cells are present in numerous parts of the human body,
including the heart and blood vessels. During an acute allergic
reaction, activated mast cells degranulate and release large
amounts of mediators, such as histamine, tryptase, platelet
activating factor, leukotrienes and thromboxane. These have
been experimentally shown to cause coronary artery spasm or
plaque rupture.
Two types of KS have been described. The type I variant
(coronary spasm), which may represent a manifestation of
endothelial dysfunction or microvascular angina, includes
Fig. 1. The electrocardiogram shows slight ST-segment elevation in the inferior leads.
Fig. 2. The patient’s left (A) and right coronary arteries (B) were normal on coronary angiography.