DOI: 10.12890/2026_006244

When allergy strikes the heart: Kounis syndrome and cardiac arrest

Authors

  • Marta Chiara Sircana Department of Medical, Surgical and Pharmacology, University of Sassari, Sassari, Italy 0009-0006-5494-5255
  • Roberto Manetti Department of Medical, Surgical and Pharmacology, University of Sassari, Sassari, Italy 0000-0001-7376-2303
  • Gavino Casu Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy 0000-0001-9923-9473
  • Alfredo Caturano Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma University, Rome, Italy 0000-0001-7761-7533

martachiara.si@gmail.com

Keywords

Kounis syndrome, coronary vasospasm, NSAID, hypersensitivity, ventricular fibrillation

Abstract

Introduction: Kounis syndrome is an acute coronary syndrome precipitated by allergic or hypersensitivity reactions and mediated by the release of inflammatory substances that affect the coronary circulation. In spite of increasing awareness of this syndrome, it remains underdiagnosed, particularly in young patients without conventional cardiovascular risk factors.
Case description: We report the case of a patient with recurrent Kounis syndrome presenting with two distinct acute coronary syndromes within one month, initially classified as myocardial infarction with nonobstructive coronary arteries and subsequently recognised after angiographic documentation of transient coronary vasospasm. A 28-year-old man with a history of non-steroidal anti-inflammatory drug (NSAID) hypersensitivity presented with acute chest pain shortly after NSAID intake. Electrocardiography showed ischemic changes, and cardiac biomarkers showed a modest elevation. Coronary angiography revealed severe, reversible multivessel coronary artery spasm in the absence of structural coronary disease, consistent with type I Kounis syndrome. During the procedure, the patient developed ventricular fibrillation, successfully treated with electrical defibrillation and intracoronary nitrates. Left ventricular function fully recovered, and the patient was discharged with strict avoidance of NSAIDs. Subsequent allergological evaluation confirmed NSAID hypersensitivity.
Conclusion: This case highlights that type I Kounis syndrome may present as a severe acute coronary syndrome complicated by malignant ventricular arrhythmias. A careful allergological and pharmacological history is essential for accurate diagnosis, guide management, and prevent recurrent potentially fatal events.

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References

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Published

2026-02-17

Issue

Vol. 13 No. 3 (2026)

Categories

How to Cite

1.
Sircana MC, Manetti R, Casu G, Caturano A. When allergy strikes the heart: Kounis syndrome and cardiac arrest. EJCRIM [Internet]. 2026 Feb. 17 [cited 2026 Nov. 3];13(3). Available from: https://ejcrim.com/index.php/ejcrim/article/view/6244