Kounis Syndrome with Syncope, Yasser’s Hypocalcemic Sign, and Possible Pulmonary Embolism after AstraZeneca ChAdOx1 nCoV-19 Vaccine in Elderly; Risk and Management

Authors: Elsayed YMH*

DOI: 10.23880/vvoa-16000171

Volume 9, Issue 2

Abstract

Rationale: Kounis-Zafras syndrome is an acute coronary syndrome (ACS) caused by exposure to an allergic substance. Interestingly, Wavy triple and Wavy double ECG signs (Yasser’s sign) are new specific diagnostic and therapeutic signs seen in the cases of hypocalcemia. The AstraZeneca ChAdOx1 nCoV-19 Vaccine is a viral vector vaccine for the prevention of COVID-19. This vaccine was developed by the UK Oxford University and British-Swedish company AstraZeneca using the modified chimpanzee adenovirus ChAdOx1. Pulmonary embolism and myocardial infarction are the final steps for thromboembolic cardiorespiratory disease. Atrial fibrillation (AF) is a hallmark of an increasing risk of pathological thrombus formation due to a disruption of physiological hemostatic mechanisms. Patient concerns: An elderly widow Farmer male patient was presented to the physician outpatient clinic with angina, syncope, tachypnea, and latent tetany within 8 hours after injection of AstraZeneca ChAdOx1 nCoV-19 vaccine during the vaccination campaign for a traditional COVID-19 prophylaxis. Diagnosis: Kounis-Zavras syndrome with syncope, Wavy triple sign (Yasser’s sign), COVID-19 reactivity, and possible pulmonary embolism after AstraZeneca ChAdOx1 nCoV-19 vaccine in a senile patient with a silent myocardial infarction and chronic atrial fibrillations. Interventions: Electrocardiography, oxygenation, calcium intravenous infusion, and echocardiography. Outcomes: A dramatic clinical, and electrocardiographic improvement had happened. Lessons: AstraZeneca ChAdOx1 nCoV-19 vaccine may induce Kounis-Zafras syndrome, COVID-19 reactivity, possible pulmonary embolism, and hypocalcemia. The associated Kounis-Zafras syndrome, COVID-19 reactivity, possible pulmonary embolism, and hypocalcemia after AstraZeneca ChAdOx1 nCoV-19 vaccine-inducing Kounis-Zafras syndrome are innovative cardiovascular findings. Atrial fibrillation with silent inferior myocardial infarction, low-targeted INR, senility, and male sex are constellation serious risk factors.

Keywords: Allergic Coronary Syndrome; Kounis-Zafras Syndrome; Wavy Triple Sign; Wavy Double Sign; Yasser’s Sign; Hypocalcemia; Astrazeneca Chadox1 Ncov-19 Vaccine; Coronary Artery Spasm; Ischemic Heart Disease

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