Case report and review of literature on acute NSTEMI after fluorescein angiography in a 76-year-old woman

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Frontiers in Medicine Published May 18, 2026 Medically reviewed May 18, 2026 DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Consider rare NSTEMI risk after fluorescein angiography in patients with coronary disease.

This publication is a case report and review of the literature focusing on a single case involving a 76-year-old woman with a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus. The patient underwent fluorescein angiography in a clinic and emergency department setting. Approximately 10 minutes after the procedure, the patient experienced acute central chest pain and non-ST-elevation myocardial infarction. The absolute number of cases reported is one, and statistical measures such as p-values or confidence intervals were not reported.

The authors discuss potential underlying mechanisms for this event. These include an allergic-mediated coronary vasospasm, also known as Kounis syndrome, or anxiety-related catecholamine release in a pre-existing diseased myocardium. The adverse events observed included acute central chest pain, hypertension, and non-ST-elevation myocardial infarction. The non-ST-elevation myocardial infarction was classified as a serious adverse event. The follow-up period extended until stabilization and discharge.

The authors note that this is an extremely rare and life-threatening complication. There were no reported discontinuations of the intervention. The study lacks a comparator group. The authors emphasize the critical importance of thorough patient counseling, clinical vigilance, and institutional readiness to manage acute systemic emergencies associated with fluorescein angiography. Funding sources and conflicts of interest were not reported.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

IntroductionFluorescein 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 presentationA 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.ConclusionThis 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.