A 79-year-old man with a history of hypertension and heavy smoking.
She had no history of allergy.
Four months ago, the patient developed progressive angina and underwent coronary angiography, which showed severe lesions in the proximal third of the right coronary artery (RC) and another in the middle third of the anterior descending artery (ADA).
DC was considered the vessel responsible for the condition and underwent angioplasty with implantation of a Driver stent (Medtronic Inc.) in its proximal segment.
Due to the persistence of stress angina CF2 (SCC) that did not respond to usual treatment, she was admitted to our institution for a new angiographic study.
A right radial coronary angiography 6F was performed, after administration of 50 ug IV fentanyl and local anesthesia with lidocaine.
Imixanol was used as intravascular contrast agent.
Immediately after the CD study, which showed no significant lesions or re-intestinal aerosolized therapy hydrobutterol, the patient developed a papulomacular rash with universal distribution and bronchospasmo, so 200 mg was administered.
Immediately, she developed severe back pain associated with bradycardia and hypotension, with a ST-segment elevation in the lower leads and complete atrioventricular block on the monitor.
Once again, a diffuse and severe CD compromise was injected, which reversed transiently with the use of intracoronary nitroglycerin.
The phenomenon was repeated on multiple occasions, even after coronary administration of verapa spasm dose of 200 to 400ug and continuous infusion of nitroglycerin in increasing doses until the event was achieved.
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Finally, angiography of the LAD showed a moderate lesion in the middle third and a severe lesion in the distal third.
Considering a probable condition of hypersensitivity as a trigger of the event, a simple angioplasty of the distal lesion was performed, as well as a determination of the distal flow reserve (Pressure Wire).
RADI Medical Systems AB) was non-hemodynamically significant in the middle third lesion (RFF 0.88).
She was admitted to the Coronary Care Unit where oral calcium antagonists and nitrates were initiated the following day, aspirin, statins and loratadine; there was no increase in markers of myocardial injury.
She was discharged after 3 days, remaining asymptomatic in a clinical follow-up of ten months.
The association of hypersensitivity and severe coronary spasm in the absence of previous history of vasospastic angina is a diagnostic unit Kounis syndrome1.
