Microvascular angina due to microvascular coronary vasospasm

Coronary spasm and hypersensitivity to amoxicillin: Kounis or not Kounis syndrome?

“…It is more frequent in 40-to 50-year-old males, smokers, and typically presented as short episodes at rest that usually respond to calcium antagonists and/or nitrates [5]. Pathophysiology of coronary spasm involves a local hyperreactivity of a coronary segment to a vasoconstrictor stimulus.…”

“…These favour vasoconstriction, collagen destruction and plaque erosion or rupture, which may trigger an acute coronary syndrome [1,2]. In fact, high levels of histamine have been found in patients with vasospastic angina [4], although no definitive studies have shown a causal relationship between the allergic reaction and the ensuing acute coronary syndrome [5].…”

“…Ureteroileourethrostomy predisposes to chronic metabolic acidosis, which may worsen in situations such as infections or anemia [6]. It is known that severe metabolic acidosis produces tissular hypoxia and disorders of coronary microcirculation, which could explain the onset of an acute coronary syndrome [5]. Therefore, although an allergen hypersensitivity and Kounis syndrome could be considered to explain coronary spasm in our patient, other underlying disorders, like severe metabolic acidosis, may have probably played a more significant role in the onset of angina.…”

“…Although some studies have found elevation of histamine and other markers of mast cell activation [4], none of them have demonstrated a causal relation between allergic reaction and acute coronary syndrome, and other common or uncommon mechanisms of angina have not been systematically ruled out [5].…”