Allergy, infarction, and stress cardiomyopathy: in-depth analysis of a complex clinical case report

Abstract

Background: Diagnosis of Kounis syndrome, an acute coronary syndrome associated with anaphylactic reactions, is challenging owing to the overlapping symptoms of myocardial ischemia. Takotsubo syndrome (TTS), characterized by stress-induced cardiomyopathy, may share pathophysiological mechanisms with Kounis syndrome and potentially coexist in the same patient.

Case Presentation We present a case of a 63-year-old patient who developed an allergic reaction to contrast medium administration, leading to dyspnea and chest pain. Electrocardiography revealed a new-onset left bundle-branch block, and echocardiography indicated wall motion abnormalities with apical ballooning, suggestive of TTS. Coronary angiography displayed a chronic total occlusion of the right coronary artery. Laboratory tests revealed elevated inflammatory markers, supporting the diagnosis of Kounis syndrome and TTS.

Conclusion: This case highlights the challenges of diagnosing and managing type II Kounis syndrome associated with concurrent TTS. This underscores the need for tailored therapeutic interventions and comprehensive guidelines to address these complex conditions effectively.

Keywords

Allergic vasospastic angina / Anaphylaxis / Case report / Kounis syndrome / Takotsubo syndrome

Conflict of interest statement

The authors declare no conflict of interest.

Author contributions

Cacciapuoti F, Capone V, and Cacciapuoti F drafted the work; Cacciapuoti F, Golino P, Pezzullo E, Bossone E, and Cacciapuoti F were major contributors in writing the manuscript and substantively revised it. All the authors have read and approved the final version of the manuscript.

Funding

None.

Ethical approval of studies and informed consent

The study followed the principles of the Declaration of Helsinki as re-vised in 2013. Written informed consent was obtained from the pa-tient. The publication of individual case report is exempt from ethical approval according to the Antonio Cardarelli Hospital guidelines.

Acknowledgments

Capone V was supported by the Cardiopath PhD program.

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