CONGRESS ABSTRACT

Myocardial infarction without significant coronary artery stenosis (MINOCA) can be likened to a Pandora's box, revealing various underlying etiologies, including coronary spasm. The etiological diagnosis is not always straightforward. It is also known that 3-24% of MINOCA cases present with ST-segment elevation. We present the case of a 51-year-old male who was admitted to the Emergency Department following an anaphylactic reaction to shellfish ingestion, which was treated with intravenous epinephrine, methylprednisolone, and chlorphenamine. Immediately after treatment, the patient developed chest pain, and his ECG showed ST-segment elevation in the infero-lateral leads, prompting emergency coronary angiography, which revealed no significant coronary stenosis. Key findings during hospitalization included a peak troponin I level of 10,558 pg/L and an elevated white blood cell count. Echocardiography showed preserved left ventricular ejection fraction. Is this Takotsubo syndrome or Kounis syndrome? Although both syndromes can coexist in some cases, based on the elevated troponin levels and the absence of typical kinetic abnormalities, we favored the diagnosis of Kounis syndrome. Additionally, it is important to note that the administration of epinephrine, through its α1-adrenergic vasoconstrictive effects, β1-adrenergic receptor activation, and promotion of platelet aggregation and activation, may exacerbate myocardial ischemia, induce coronary vasospasm, and contribute to the onset of arrhythmias. Kounis syndrome is an acute coronary syndrome associated with significant activation of mast cells and platelets during anaphylaxis. The most common Type I variant is induced by coronary spasm mediated by inflammatory mediators and is typically treated with corticosteroids. Cardiac MRI demonstrated hypokinesia of the true apex, the inferolateral wall, and the apical inferior septum, with corresponding areas of ischemic pattern enhancement. We initiated treatment with methylprednisolone and loratadine, along with anti-ischemic therapy, resulting in gradual clinical improvement.