CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 9/10, October/November 2013
AFRICA
e15
to the cardiogenic episode, cannot be ruled out in this patient’s
case. Asano
et al
.
8,9
studied drug provocation tests in patients
with vasospastic angina and found that more than 25% of the
patients had multi-vessel spasms.
Although prognosis is good for vasospastic angina patients,
sudden cardiac death is not uncommon. Multi-vessel spasm can
result in a large area of ischaemic myocardium, and vasospasm
occurs frequently in the affected vessels, which can easily induce
major cardiovascular accidents, including malignant arrhythmias
and sudden death.
The patient described here had a history of bronchial asthma
and allergies for many years. Laboratory tests after admission
showed normal values of high-sensitivity C-reactive protein and
immunoglobulin, but the patient’s eosinophils and IgE titres were
significantly increased. In combination with the characteristics
of chest pain and the coronary angiogram, Kounis syndrome
was diagnosed.
Kounis syndrome is an allergy-related acute coronary
syndrome (ACS) associated with ST-segment elevation, including
allergic angina and myocardial infarction.
10
Characteristics of
Fig. 4. A. Coronary angiograph of the left coronary artery. No significant stenosis was present in the left anterior
descending or circumflex coronary arteries. B. First coronary angiography of the right coronary artery. Multiple severe
stenoses were found in segments one to three of the right coronary artery, narrowing to 85%. C. Second coronary
angiography of the right coronary artery. Multiple moderate stenoses were found in segments one to three of the right
coronary artery, narrowing to 50%. D. Third coronary angiography of the right coronary artery. No significant stenosis
was present in the right coronary artery.
A
C
B
D
