A case of takotsubo cardiomyopathy associated with Kounis syndrome

A sixty-five-year old female, with a past history of variant angina and asthma, collapsed after complaining of chest pain and regained spontaneous circulation by resuscitation. An electrocardiograph showed a QS pattern on the precordial leads and sonography revealed a takotsubo cardiomyopathy-like movement. During induced hypothermic therapy for protection of her brain and heart using a drug which dilated the coronary artery, she collapsed again with ventricular flatter for 40 min; however, she re-obtained return of spontaneous circulation and eventually regained consciousness. After correction of eosinophilia by steroids, the variant angina with life-threatening arrhythmia and asthma attack subsided. She was discharged and ambulatory 14 days after admission with normal motion of the cardiac wall. This is the first case of Kounis syndrome associated with takotsubo cardiomyopathy. The mechanism of the concurrent condition of this case is herein discussed.