Vasospastic angina induced by nonsteroidal anti‐inflammatory drugs

Abstract

Summary:We report two cases of vasospastic angina associated with anaphylactic reaction caused by nonsteroidal antiinflammatory drugs (NSAIDs). Both patients exhibited anaphylactic manifestations, such as general rash and urticaria, along with angina pectoris with electrocardiographic ST-segment elevations after suppository administration of diclofenac sodium or indomethacin, the most commonly used NSAIDs. Although these patients had normal coronary arteriograms, intracoronary administration of ergonovine or acetylcholine provoked diffuse coronary artery spasms accompanied by chest pain and ischemic ST-segment changes. It is therefore suggested that an allergic mechanism may be involved as a causative factor of the coronary artery spasm induced by NSAIDs.

Kounis syndrome (allergic angina and allergic myocardial infarction): A natural paradigm?

“…Several reports have shown that type I variant of Kounis syndrome has better prognosis than type II variant [108]. However, in both types the prognosis depends on the magnitude of the initial allergic response, the patient's sensitivity, the patient's comorbidity, the site of antibodyantigen reaction, the allergen concentration and the route of allergen entrance.…”

Myocardial Infarction in the Setting of Anaphylaxis to Celecoxib: A Case of Kounis Syndrome

“…Individuals with atopy are at increased risk of developing Kounis syndrome compared to normal individuals, and often experience worse symptoms due to an amplified inflammatory response (10,11). Prognosis depends on several elements, including magnitude of the initial response, patient sensitivity, comorbidity, site of antibody-antigen reaction, allergen concentration, and the route of allergen entrance (12). Although adults are more frequently affected, events in children have also been documented (13,14).…”

Catheter-induced Vasospasm of Both the Right External Iliac and Right Coronary Arteries During Coronary Angiography

“…Proposed mechanisms include mechanical irritation triggering a myogenic reflex [6,7], stress receptor activation [8], and platelet aggregation at the catheter tip with release of vasoactive agents [9]. Several underlying etiologies have been documented including hypercholesterolemia, ergot toxicity, exercise, L-thyroxin therapy, hyperosmolar contrast medium, nonsteroidal anti-inflammatory drugs, cigarette smoking, and alcohol [7,8,[10][11][12][13][14][15][16][17][18]. In accordance with the presence of mild coronary artery disease (CAD) in the LAD and LCx in this patient, she also fits the typical prototype of patients predisposed to coronary vasospasm as previously defined by provocative testing with ergonovine [19].…”