Podcast #286: Coronary Vascular Conditions that aren’t STEMI

Author: Don Stader, M.D.

Educational Pearls

• While we usually associate the coronary vasculature with STEMIs, there are other pathologies that can affect the heart’s blood supply.
• Kounis syndrome: an allergic vasospasm of the coronary arteries. This can happen post anaphylaxis or be caused by a stent allergy. It is best treated with aggressive management of the allergic reaction.
• Kawasaki disease: An autoimmune condition that presents in kids as conjunctivitis, lymphadenopathy, hand/foot swelling, rash, and fever. It can also cause coronary aneurysms, which can rupture and be rapidly fatal.  
• Prinzmetal angina: Caused by coronary vasospasm. Presents with transient chest pain at rest. Treat with CCBs.
• Cocaine: Causes coronary vasospasm. Cocaine-induced vasospasm is best treated with BZDs.
• Coronary artery dissection: increased risk in pregnant women and those with connective tissue disorders.

References:  Memon S, Chhabra L, Masrur S, Parker MW. Allergic acute coronary syndrome (Kounis syndrome). Proceedings (Baylor University Medical Center). 2015;28(3):358-362.