Cardiovascular Journal of Africa: Vol 34 No 4 (SEPTEMBER/OCTOBER 2023)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 4, September/October 2023 AFRICA 259 both myocardial reperfusion/revascularisation and allergic reaction.20 Corticosteroids and antihistamines are beneficial for the alleviation of inflammation and are helpful for the reversal of coronary vasospasm in the type I variant.21 In patients with type II variants, treatment should be directed by ACS treatment guidelines, in addition to steroids and antihistaminics.22 The management of the type III variant would be much more complicated, even needing stent extraction when necessary.23 Conclusion The main lesson of this case is that high suspicion of Kounis syndrome is needed when there is an allergic history with cardiac symptomatology. Only with increased awareness of this entity can more prompt initiation of treatment be achieved. Although in the majority of patients, the onset of clinical symptoms and signs are within one hour of trigger exposure,5 it could also present as a subacute or even chronic course. Measuring serum cardiac enzymes and cardiac-specific troponins is helpful in determining the level of cardiac damage associated with allergic insults. Echocardiography and coronary angiography are also indispensable in measuring cardiac wall abnormalities and management of coronary stenosis. Perhaps Kounis syndrome has been overlooked and underdiagnosed in China and being more vigilant about this condition in clinical practice may not only improve patient care but also lead to the discovery of more causative factors in the future. References 1. Pfister CW, Plice SG. Acute myocardial infarction during a prolonged allergic reaction to penicillin. Am Heart J 1950; 40(6): 945–947. 2. Kounis NG. Coronary hypersensitivity disorder: the Kounis syndrome. Clin Ther 2013; 35(5): 563–571. 3. Kounis NG. 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