Myocardial infarction following fluorescein angiography: a case report and review of the literature

Introduction: Fluorescein angiography (FA) is a commonly utilized procedure to evaluate retinal vasculature. Although relatively safe, the procedure carries a small risk of serious life-threatening adverse reactions. The purpose of this report is to describe a case of a non-ST-elevation myocardial infarction (NSTEMI) after fluorescein angiography. Case presentation: A 76-year-old woman with a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus presented to the clinic with subacute-onset bilateral vision and hearing loss. Ophthalmic exam demonstrated neovascularization of the optic disc and iris in the left eye. A recent brain magnetic resonance imaging (MRI) suggested systemic vasculitis. FA was obtained to rule out Susac syndrome and evaluate for possible vasculitic etiology of her vision loss. Approximately 10 min after the procedure, she developed acute central chest pain and hypertension. She was sent to the emergency department (ED), and workup revealed a non-ST-elevation myocardial infarction for which she was admitted. Cardiac catheterization confirmed an occlusion of the right coronary artery. She was managed medically and subsequently discharged upon stabilization. Conclusion: This case reports the extremely rare and life-threatening complication of acute myocardial infarction following FA. Possible underlying mechanisms include an allergic-mediated coronary vasospasm (aka Kounis syndrome) or anxiety-related catecholamine release in pre-existing diseased myocardium. This event underscores the critical importance of thorough patient counseling, clinical vigilance, and institutional readiness to manage acute systemic emergencies associated with this common procedure.