Intraoperative Kounis Syndrome and Fixation Errors: A Case Report

Trent A Ogaz; BobbieJean Sweitzer

doi:10.1213/XAA.0000000000001672

Intraoperative Kounis Syndrome and Fixation Errors: A Case Report

A A Pract. 2023 Mar 20;17(3):e01672. doi: 10.1213/XAA.0000000000001672. eCollection 2023 Mar 1.

Authors

Trent A Ogaz¹, BobbieJean Sweitzer^{1

2}

Affiliations

¹ From the University of Virginia School of Medicine, Charlottesville, Virginia.
² Inova Health System, Falls Church, Virginia.

PMID: 36940363
DOI: 10.1213/XAA.0000000000001672

Abstract

Postinduction hypotension, though frequently due to anesthetic medications, has a variety of causes. We present a case of presumed intraoperative Kounis syndrome, or anaphylaxis-induced coronary vasospasm, in which the patient's perioperative course was initially attributed to anesthesia-induced hypotension and iatrogenic rebound hypertension leading to Takotsubo cardiomyopathy. A second anesthetic event with immediate recurrence of hypotension after the patient received levetiracetam appears to confirm the diagnosis of Kounis syndrome. In this report, we discuss the fixation error that led to this patient's original misdiagnosis.

Publication types

Case Reports

MeSH terms

Anaphylaxis* / chemically induced
Coronary Vasospasm* / chemically induced
Coronary Vasospasm* / diagnosis
Humans
Hypotension* / chemically induced
Hypotension* / complications
Kounis Syndrome* / diagnosis
Kounis Syndrome* / etiology