• Enbiya Aksakal, Mecit Kantarci, Ayhan Akoz, Atif Bayramoglu, Mustafa Uzkeser, and Mucahit Emet.
• Department of Emergency Medicine, Ataturk University Medical Faculty, 25240 Erzurum, Turkey. akozayhan@gmail.com
• Am J Emerg Med. 2012 Nov 1;30(9):2086.e5-7.

AbstractKounis syndrome (KS) is an acute coronary vasospasm after exposure to an allergen due to mast cell degranulation and existing mediators. Various drugs, conditions, and environmental exposures can cause KS. We presented 2 cases, 1 of whom had taken an antiflu drug (containing paracetamol, pseudoephedrine, and dextromethorphan). His electrocardiogram (ECG) showed inferior ST elevations (2 mm) with normal cardiac biomarkers. His cardiac magnetic resonance imaging showed hypokinesis and myocardial hibernation on apical septum and on the left ventricle. The second patient took a pill of naproxen sodium. The ECG showed 1-mm ST elevation in leads DII, V5, and V6. His troponin was markedly elevated. These cases showed that there seems to be no correlation with ECG and troponin levels in KS. In addition, for patients in whom KS type 1 is expected without troponin elevation, noninvasive cardiac magnetic resonance imaging study seems to be appropriate for the diagnosis of KS.

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