Two Needles in a Haystack: Acute Occlusion Myocardial Infarction Presenting With South Africa Flag Sign Possibly Due to Kounis Syndrome-A Review and Case Report

Scritto il 29/10/2026
da Andrew Bowman

Adv Emerg Nurs J. 2026 Oct-Dec 01;48(4):235-242. doi: 10.1097/TME.0000000000000652.

ABSTRACT

The paradigm of STEMI/NSTEMI (ST segment Elevation Myocardial Infarction/Non-ST segment Myocardial Infarction) is being supplanted by the new OMI (Occlusion Myocardial Infarction) ideology to better capture those patients who do not present with classic ST segment elevation on initial and even subsequent electrocardiograms (ECGs) but still represent patients with myocardium at risk from coronary artery occlusion and would benefit from timely, less than 2-hour, percutaneous coronary intervention. The first needle in the haystack from this case report was the prompt recognition of evolving "South Africa Flag" ECG changes of OMI in the setting of possible allergic reaction and its subsequent treatment, also known as Kounis syndrome, which represents the second possible but unconfirmed needle.

PMID:42955898 | DOI:10.1097/TME.0000000000000652