Kounis-Zafras Syndrome from Diclofenac Potassium: Novel ECG Signs Post-CABG

Objective: This article aimed to clarify how diclofenac potassium can induce Kounis-Zafras syndrome from diclofenac potassium with novel ECG signs in patients who have undergone coronary artery bypass graft.
Introduction: Kounis-Zafras syndrome is an allergic acute coronary syndrome (ACS) following an allergenic exposure. Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used to treat pain and inflammatory diseases. First-degree heart block or PR-interval prolongation is mostly an incidental electrocardiographic (ECG) sign with a characteristic prolonged PR-interval. Interestingly, Wavy triple and Wavy double ECG signs (Yasser’s sign) are new specific diagnostic and therapeutic signs seen in the cases of hypocalcemia. Triphasic Yasser’s stressor syndrome is a sequel and constellation of the vicious cycle of Yasser’s Stressor test passing three stages in the form of fear, calm, and fear (Fear-Calm-Fear Yasser’s syndrome). A coronary artery bypass graft (CABG) is evidence of a previously severe ischemic heart disease.
Methods: An observational-retrospective case report for a middle-aged married female diabetic patient was admitted to the intensive care unit with angina, PR-interval prolongation, Wavy triple, and Wavy double ECG signs after ingestion of diclofenac potassium in a previous coronary artery bypass graft (CABG).
Results: Diclofenac potassium-inducing Kounis-Zafras syndrome with intertwining first-degree heart block, Wavy triple sign, Wavy double sign (Yasser’s signs), and Triphasic Yasser’s stressor syndrome post-CABG in a middle-aged female diabetic patient.
Conclusion: A dramatic clinical, and electrocardiographic improvement had happened. Diclofenac potassium may be inducing Kounis-Zafras syndrome. An associated first-degree heart block with Triphasic Yasser’s stressor syndrome after diclofenac potassium-inducing Kounis-Zafras syndrome are innovative cardiovascular findings. First-degree heart block, Triphasic Yasser’s stressor syndrome, CABG, diabetes, Wavy triple sign, Wavy double sign (Yasser’s signs), left ventricular hypertrophy, and female sex are constellation serious factors.
Keywords: Allergic Coronary Syndrome, Kounis-Zafras Syndrome, Wavy Triple Sign, Wavy Double Sign, Yasser’s Sign, Hypocalcemia, Stress Test, Coronary Artery Spasm, Ischemic Heart Disease, Triphasic Yasser’s Syndrome, Yasser’s Stressor Test.