100498 - Perioperative Kounis syndrome

Perioperative Kounis syndrome (KS) represents a rare yet consequential condition delineated by the coexistence of acute coronary syndrome alongside an allergic or anaphylactic reaction during the perioperative timeframe. It encompasses mast cell activation and platelet aggregation, resulting in coronary artery spasm or myocardial infarction. This syndrome can be precipitated by various factors, including pharmacological agents and allergens encountered during surgical procedures. Comprehending their pathophysiology, diagnosis, and management is imperative to enhance patient outcomes in perioperative environments.

A 69-year-old female patient. Her medical history includes bronchial asthma regulated by pollen hypersensitivity. During the surgical procedure for an ankle fracture, she experiences general malaise and sensations of dizziness. An electrocardiogram is conducted at that juncture, revealing ST segment depression in leads II, III, aVF, and negative T waves on the inferior aspect. The patient did not report any thoracic pain at any point nor exhibit mobilization of cardiac enzymes. Rescue pharmacotherapy was administered, comprising corticosteroids and epinephrine. The patient achieved complete recovery in less than thirty minutes. Subsequently, cardiac echocardiography and coronary computed tomography were conducted, which did not reveal any structural cardiac abnormalities or coronary artery involvement. Upon inquiring, the patient alludes to a clinically analogous episode during her prior surgical intervention, a termination of pregnancy thirty years prior.

During the procedure, the following pharmacological agents were administered: lidocaine, fentanyl, cefazolin.

Prick and intradermal testing are performed utilizing lidocaine and cefazolin.

Although KS is an infrequent condition, its capacity to induce life-threatening complications necessitates heightened awareness among healthcare practitioners, particularly in perioperative contexts. Intimate collaboration between allergists and cardiologists is advocated to optimize patient management and formulate tailored treatment strategies.