From Wellens To Kounis Syndrome: An Unlucky Patient

Ossama Maadarani 1, Zouheir Bitar 1, Sania Shoeb 2, Jadan Alsaddah 3

Affiliations

05 June 2020

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doi: 10.12890/2020_001689

Abstract

Wellens syndrome (WS) is identified by ECG changes in the precordial leads after resolution of angina chest pain. WS indicates critical stenosis of the proximal left anterior descending (LAD) artery. On the other hand, Kounis syndrome (KS) is an allergic reaction to various substances resulting in acute coronary syndrome. Contrast media can trigger the allergic reaction associated with KS. We describe a patient with WS who developed an allergic reaction to contrast media after percutaneous coronary intervention and experienced recurrent myocardial infarction on re-exposure.

Learning points: Despite its rarity, physicians and radiologists should be aware of Kounis syndrome triggered by contrast media so it can be rapidly diagnosed and treated.The initial target of the prevention and treatment of KS is avoidance of the precipitating stimulus or allergen.There are three KS variants: angina due to allergic coronary spasm, allergic myocardial infarction and allergy-induced stent thrombosis.

Keywords: Contrast media; Kounis syndrome; Wellens syndrome.

Conflict of interest statement

Conflicts of Interests: The Authors declare that there are no competing interests.

Figures

Figure 1 Biphasic T wave inversion in precordial leads suggestive of Wellens syndrome

Figure 1 Biphasic T wave inversion in precordial leads suggestive of Wellens syndrome

Figure 2 ST elevation in leads I and AVL, and ST depression in leads III, AVF and V1–V3

Figure 2 ST elevation in leads I and AVL, and ST depression in leads III, AVF and V1–V3

Figure 3 Extensive ST elevation in precordial leads V2–V5, and leads I and AVL

Figure 3 Extensive ST elevation in precordial leads V2–V5, and leads I and AVL

Figure 4 Coronary angiography (left anterior oblique and cranial view) revealing left anterior descending (LAD) artery occlusion due to stent thrombosis (arrow) LCx, left circumflex artery; LM, left main coronary artery

Figure 4 Coronary angiography (left anterior oblique and cranial view) revealing left anterior descending (LAD) artery occlusion due to stent thrombosis (arrow) LCx, left circumflex artery; LM, left main coronary artery

Figure 5 Coronary angiography (left anterior oblique and cranial view) revealing TIMI 3 flow in the proximal left anterior descending (LAD) artery after angioplasty (arrow) LCx, left circumflex artery; LM, left main coronary artery

Figure 5 Coronary angiography (left anterior oblique and cranial view) revealing TIMI 3 flow in the proximal left anterior descending (LAD) artery after angioplasty (arrow) LCx, left circumflex artery; LM, left main coronary artery

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