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Iodinated contrast media induced Kounis syndrome during coronary angiogram: a life-threatening clinical dilemma
  1. Romain Bonnet1,
  2. Allal Mahmoudi2,
  3. Guillaume Carrel3 and
  4. Stephane Cook2
  1. 1 Internal Medicine Department, HFR Fribourg Hopital Cantonal, Villars-Sur-Glane, Fribourg, Switzerland
  2. 2 Cardiology Department, HFR Fribourg Hopital Cantonal, Villars-Sur-Glâne, Fribourg, Switzerland
  3. 3 Intensive Care Department, HFR Fribourg Hopital Cantonal, Villars-Sur-Glâne, Fribourg, Switzerland
  1. Correspondence to Dr Romain Bonnet; romain.bonnet{at}


Kounis syndrome (KS) is a well-documented hypersensitivity vasospastic reaction induced by a variety of triggers. Clinical presentation ranges from non-specific symptoms such as dizziness and nausea to myocardial infarction. Many cases of KS were reported after the use of iodinated contrast media, mainly during radiological procedures. This report describes the case of a 46-year-old man developing coronary vasospasm and anaphylactic shock at the end of percutaneous coronary intervention. Occurrence of such pathology while performing coronary angiogram is a tricky situation for the invasive cardiologist. It requires recognising a rare syndrome and interrupting the procedure to avoid extra use of contrast media even in presence of severe coronary lesions due to vasospasm. Every interventionalist should be aware of such a presentation to recognise and react promptly when facing a potentially life-threatening clinical dilemma.

  • Interventional cardiology
  • Ischaemic heart disease
  • Clinical diagnostic tests
  • Adult intensive care
  • Contraindications and precautions

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  • Contributors Data collection, redaction and patient follow-up were mainly realised by RB. AM and GC contributed to the redaction and review of the manuscript. SC provided the angiograms of the procedures shown in this article, contribute to redaction and reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.