title: Kounis syndrome with Samter-Beer triad treated with intracoronary adrenaline.
abstract: Kounis syndrome is a well-described clinical condition characterized by the simultaneous occurrence of chest pain and an allergic reaction accompanied by clinical and laboratory findings of angina caused by inflammatory mediators released during an allergic insult. We present the case of a 50-year-old male with the Samter-Beer triad of asthma, nasal polyps, and salicylate intolerance with an ST elevation myocardial infarction complicated with cardiac arrest due to multi-vessel coronary artery spasm secondary to aspirin anaphylaxis. Adrenaline is recommended during anaphylaxis but is controversial in Kounis syndrome as it may worsen coronary spasm. We report the use of intracoronary adrenaline in successfully reversing coronary artery spasm in this hemodynamically unstable patient.
authors.affiliation: Cardiology Department, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Abdul Rahman
authors.initials: AR
authors.lastname: Ihdayhid
authors.affiliation: Cardiology Department, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Jamie
authors.initials: J
authors.lastname: Rankin
mesh_terms: D000707:Anaphylaxis / Q000150:complications / Q000175:diagnosis; D001241:Aspirin / Q000009:adverse effects*; D001249:Asthma / Q000150:complications / Q000175:diagnosis; D002637:Chest Pain / Q000150:complications / Q000175:diagnosis; D023921:Coronary Stenosis / Q000188:drug therapy* / Q000209:etiology; D003331:Coronary Vessels / Q000187:drug effects; D004562:Electrocardiography / Q000379:methods; D004636:Emergency Service, Hospital; D004837:Epinephrine / Q000008:administration & dosage*; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000150:complications / Q000175:diagnosis; D035583:Rare Diseases; D018570:Risk Assessment; D012720:Severity of Illness Index; D013577:Syndrome; D016896:Treatment Outcome
chemical_list: D001241:Aspirin; D004837:Epinephrine
keywords: Kounis syndrome; Samter-Beer triad; aspirin allergy; coronary spasm; intracoronary adrenaline