Ketoprofen-inducing Sympathetic Crashing Acute Pulmonary Edema (SCAPE), Yasser's AF Variation, Angina, and Kounis-Zafras Syndrome-O2, NTG, and Furosemide Bypassing CPAP/BiPAP and Passing Death

¹Critical Care Unit, Kafr El-Bateekh Central Hospital, Damietta, Egyptian Ministry of Health (MOH), Egypt

^*Corresponding author: Yasser Mohammed Hassanain Elsayed^, Critical Care Unit, Kafr El-Bateekh Central Hospital, Damietta, Egyptian Ministry of Health (MOH), Egypt, Email: dryaser24@yahoo.com

Received Date: August 15, 2026

Published Date: September 15, 2026

Citation: Elsayed YMH. (2026). Ketoprofen-inducing Sympathetic Crashing Acute Pulmonary Edema (SCAPE), Yasser's AF Variation, Angina, and Kounis-Zafras Syndrome-O2, NTG, and Furosemide Bypassing CPAP/BiPAP and Passing Death. Mathews J Emergency Med. 10(1):72.

Copyrights: Elsayed YMH. © (2026).

ABSTRACT

Background: Drug-induced acute diseases are a very common clinical entity. Clinical cardiovascular medicine is often involved. Ketoprofen is a propionic acid subclass of nonsteroidal anti-inflammatory drugs (NSAIDs) that has antipyretic and analgesic actions. Several cardiovascular and non-cardiovascular causes have been implicated in inducing atrial fibrillation (AF). O2, NTG, and Furosemide are essential cardiorespiratory therapies. Mast cell activation disorders are a keystone for understanding allergic angina with acute coronary syndromes (ACS), which are known as Kounis-Zafras (KZ) syndrome. Nitroglycerine (NTG) and CPAP/BiPAP have a role in the management of SCAPE, serious acute pulmonary edema.

Case Presentation: A middle-aged Egyptian wood polisher patient was admitted to the intensive care unit (ICU) with sympathetic-crashing acute pulmonary edema (SCAPE), angina, and atrial fibrillation after ingestion of a ketoprofen tablet, with implicated Kounis-Zafras syndrome. Electrocardiography, oxygenation, IV nitroglycerine infusion, IV furosemide injection, CXR-PA viewing, and echocardiography were the interventions. A dramatic clinical and electrocardiographic improvement occurred.

Conclusion: Sympathetic-crashing acute pulmonary edema (SCAPE), Yasser's AF variation, angina, and Kounis-Zafras syndrome are probable adverse effects of ketoprofen. Yasser's AF variation is a new phenomenon described as a zigzag line up and down in AF that involves the amplitude and depth of QRS complexes, affecting some leads of ECG and cardiovascular medicine. The disappearance of Yasser's AF variation after management may support the efficacy of oxygenation, IV nitroglycerine infusion, and IV furosemide injection. Kounis-Zafras type II syndrome may be implicated as a theory in the interpretation of ketoprofen-induced severe acute pulmonary edema, angina, and atrial fibrillation. Dramatic clinical and electrocardiographic improvement after early management with oxygenation, IV nitroglycerine infusion, and IV furosemide injection plays a role in hastening recovery from serious acute pulmonary edema without the need for CPAP/BiPAP. It may be attributed to their efficacy in the treatment of fatal SCAPE.

Keywords: Kounis-Zafras syndrome, Allergic angina, Ketoprofen, Sympathetic crashing acute pulmonary edema, SCAPE, Yasser's AF variation, Oxygen, Nitroglycerine, Furosemide, CPAP/BiPAP, Passing Death

ABBREVIATIONS

ACS: Acute Coronary Syndrome

AF: Atrial Fibrillation

AMI: Acute Myocardial Infarction

BiPAP: Bilevel Positive Airway Pressure

CAS: Coronary Artery Spasm

CBC: Complete Blood Count

CPAP: Continuous Positive Airway Pressure

DIAF: Drug-induced AF

ECG: Electrocardiography

ICU: Intensive Care Unit

IHD: Ischemic Heart Disease

KZ syndrome: Kounis-Zafras syndrome

LAD: Left Axis Deviation

NSR: Normal Sinus Rhythm

MI: Myocardial Infarction

NSAIDs: Nonsteroidal Anti-inflammatory Drugs

NTG: Nitroglycerine

O2: Oxygen

SCAPE: Sympathetic Crashing Acute Pulmonary Edema

VR: Ventricular Rate