A 24-year-old man presented to the casualty department with a history of left-sided, colicky abdominal pain for one day. It was associated with an inability to pass flatus or motion within the same duration. There was no history of vomiting. On examination, the vital signs were within normal limits, and he was afebrile. His abdomen was soft, but a hard mass was palpable on the left side of his abdomen. There was no peritonitis. The bowel sounds were sluggish.

Kounis syndrome (KS) is defined as acute coronary syndrome (ACS) induced by coronary vasospasm associated with an anaphylactic reaction. This condition was described in 1991 by Kounis, detailing potential pathophysiological pathways for coronary spasm. We report a case of Type 2 KS – a patient with stented coronary artery disease who presented with ST-elevation myocardial infarction (STEMI) following intramuscular Diclofenac Sodium.

Myocardial infarction (MI) in the young adults are more common among the Asians compared to the Caucasians. It is of great interest to investigate the genetic risks that increase the susceptibility of MI in young patients with no family history. We conducted a genetic analysis on a young adult diagnosed with acute MI. The coronary angiogram showed acute complete occlusion of the left anterior descending artery with 40% left ventricular ejection fraction (LVEF). Patient’s DNA was subjected to genotyping using Infinium Asian Screening Array. The genotypes were annotated and associated with risks of cardiovascular diseases catalogued in GWAS database. Ninety-four genetic variants were detected. Patient has more than half of the genetic variants being homozygous risk genotypes for coronary artery and coronary heart diseases. Identifying the potential genetic modifiers associated with MI in young patients is of great interest to help the clinician make informed decisions to implement preventive and personalised medicine for this patient.