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Liao R, Cheng S, Xu N. Case Report: Kounis syndrome due to cryptopteran bite. Front Cardiovasc Med 2024; 11:1339514. [PMID: 38380174 PMCID: PMC10877037 DOI: 10.3389/fcvm.2024.1339514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024] Open
Abstract
Background Kounis syndrome is an acute coronary syndrome (ACS) caused by allergic reactions, including coronary artery spasm (type I) caused by allergies without coronary predisposing factors, pre-existing coronary atherosclerosis, and coronary artery disease. Anaphylaxis leads to plaque rupture or erosion leading to acute myocardial infarction (type II) and acute coronary stent thrombosis (type III). Here we share a case of Kounis syndrome type I caused by an allergy caused by a Cryptopteran bite. Case presentation A 47-year-old woman was admitted to the hospital due to an insect bite for 2 days and chest distress for more than 3 h. Outside the hospital, electrocardiogram(ECG) showed sinus rhythm, ST-segment elevation in leads V1-V3, high-sensitivity troponin 2.54 ng/ml(0-0.5 ng/ml). One hour later, the ECG of the patient showed that the ST segment elevation of lead V1-V4 was 0.10-0.20 mV. Emergency coronary angiography showed coronary spasm and moderate lumen stenosis in the middle segment of left anterior descending artery (LAD). After treatment, the patient's symptoms were relieved, and the ST segment of lead V1-V4 of electrocardiogram returned to normal. Conclusion Kunis syndrome is a life-threatening condition that can also cause myocardial ischemic injury in patients with or without coronary artery disease. Timely identification and anti-allergic treatment can achieve a good prognosis.
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Affiliation(s)
| | | | - Nan Xu
- Department of Cardiology, The First People’s Hospital of Neijiang, Neijiang, China
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2
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Domain G, Strubé C, Plourde B, Steinberg C, Sarrazin JF, Roy K, Poirier P, Philippon F. Acute transvenous pacemaker lead thrombosis early after implantation: A rare clinical scenario. Pacing Clin Electrophysiol 2023; 46:934-938. [PMID: 36550633 DOI: 10.1111/pace.14647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/22/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Symptomatic thrombus formation due to a permanent pacemaker (PM) lead is a rare complication. It could be associated with serious outcome and should be suspected in patients who present with unexplained right heart failure, dyspnea, or syncope following dual-chamber PM implantation. A timely decision to perform an echocardiographic examination, followed by medical, thrombolytic, or surgical treatment can be necessary. We describe the case of an 84-year-old man who presented with syncope and hypotension a few days after PM implantation. A transesophageal echocardiography revealed a mobile mass in the right atrium attached to the pacemaker lead. Intravenous heparin allowed a complete resolution of the thrombus.
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Affiliation(s)
- Guillaume Domain
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - Camille Strubé
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - Benoit Plourde
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - Christian Steinberg
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - Jean-François Sarrazin
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - Karine Roy
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - Paul Poirier
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - François Philippon
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
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3
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Alblaihed L, Huis In 't Veld MA. Allergic Acute Coronary Syndrome-Kounis Syndrome. Immunol Allergy Clin North Am 2023; 43:503-512. [PMID: 37394256 DOI: 10.1016/j.iac.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Acute coronary syndrome (ACS) in the setting of an allergic/immunologic reaction is known as Kounis syndrome. It is an underdiagnosed and underrecognized disease entity. One must keep a high index of suspicions when managing a patient presenting with cardiac as well as allergic symptoms. There are 3 main variants to the syndrome. Treating the allergic reaction may alleviate the pain; however, ACS guidelines should be followed if cardiac ischemia is present.
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Affiliation(s)
- Leen Alblaihed
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA. https://twitter.com/LeenAlblaihed
| | - Maite Anna Huis In 't Veld
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA; Department of Emergency Medicine, Diakonessenhuis Utrecht, Bosboomlaan 1, 3582 KE Utrecht, the Netherlands.
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La Cognata O, Trimarchi G, Lo Savio A, Virga V, Andò G, de Gregorio C. Kounis syndrome in a patient with multivessel coronary artery disease and DRESS. Clin Case Rep 2023; 11:e7121. [PMID: 36950673 PMCID: PMC10025948 DOI: 10.1002/ccr3.7121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/20/2023] [Accepted: 03/08/2023] [Indexed: 03/24/2023] Open
Abstract
A 68-year-old man was admitted with ST-elevation myocardial infarction and intense rash. He was diagnosed with type 2 Kounis syndrome elicited by drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and received complete revascularization with percutaneous coronary intervention. This case highlights the complex pathophysiology of acute coronary syndrome, and the elusive link between coronary occlusion and ST-segment deviations at ECG.
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Affiliation(s)
- Olga La Cognata
- Department of Clinical and Experimental Medicine, Postgraduate School of CardiologyAzienda Ospedaliera Universitaria Policlinico “Gaetano Martino”, University of MessinaMessinaItaly
| | - Giancarlo Trimarchi
- Department of Clinical and Experimental Medicine, Postgraduate School of CardiologyAzienda Ospedaliera Universitaria Policlinico “Gaetano Martino”, University of MessinaMessinaItaly
| | - Armando Lo Savio
- Department of Clinical and Experimental Medicine, Postgraduate School of CardiologyAzienda Ospedaliera Universitaria Policlinico “Gaetano Martino”, University of MessinaMessinaItaly
| | - Vittorio Virga
- Department of Clinical and Experimental Medicine, Postgraduate School of CardiologyAzienda Ospedaliera Universitaria Policlinico “Gaetano Martino”, University of MessinaMessinaItaly
| | - Giuseppe Andò
- Department of Clinical and Experimental Medicine, Postgraduate School of CardiologyAzienda Ospedaliera Universitaria Policlinico “Gaetano Martino”, University of MessinaMessinaItaly
| | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, Postgraduate School of CardiologyAzienda Ospedaliera Universitaria Policlinico “Gaetano Martino”, University of MessinaMessinaItaly
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Giraldo-Tugores M, Sanmartín-Fernández M, Fernández-Lozano C, Martínez-Botas J, De-la-Hoz-Caballer B, González-de-Olano D. Allergic contact dermatitis from nickel and coronary aneurysm. Contact Dermatitis 2023; 88:480-482. [PMID: 36799484 DOI: 10.1111/cod.14295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 01/27/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Affiliation(s)
| | | | - Carlos Fernández-Lozano
- Biochemistry-Research Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Javier Martínez-Botas
- Biochemistry-Research Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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Calogiuri G, Savage MP, Congedo M, Nettis E, Mirizzi AM, Foti C, Vacca A, Kounis NG. Is Adrenaline Always the First Choice Therapy of Anaphylaxis? An Allergist-cardiologist Interdisciplinary Point of View. Curr Pharm Des 2023; 29:2545-2551. [PMID: 37877509 DOI: 10.2174/0113816128257514231019165809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 09/14/2023] [Accepted: 09/22/2023] [Indexed: 10/26/2023]
Abstract
Worldwide, adrenaline is considered the first choice therapy in the international guidelines for the management of anaphylaxis. However, the heart and cardiovascular apparatus are strongly involved in anaphylaxis; for that reason, there are some cardiac conditions and certain anaphylaxis patterns that make epinephrine use problematic without adequate heart monitoring. The onset of Kounis syndrome, takotsubo cardiopathy, or the paradoxical anaphylaxis require great attention in the management of anaphylaxis and adrenaline administration by clinicians, who should be aware of the undervalued evolution of anaphylaxis and the potential cardiologic complications of epinephrine administration. Numerous case reports and studies describe the unexpected onset of cardiac diseases following epinephrine treatment, despite the latter being the recommended therapy for anaphylaxis. Our review suggests that future anaphylaxis guidelines should incorporate cardiovascular specialists since the treatment of Kounis syndrome or takotsubo cardiopathy requires cardiologist skills.
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Affiliation(s)
| | - Michael P Savage
- Department of Medicine (Cardiology), Thomas Jefferson University Hospital, Philadelphia, USA
| | | | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergy and Clinical Immunology, University of Bari "Aldo Moro", Bari, Italy
| | | | - Caterina Foti
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine 'G. Baccelli', University of Bari "Aldo Moro", Bari, Italy
| | - Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras 26221, Greece
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7
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Bohn A, Blumenstiel J. Update Anaphylaxie – wenig Neues, aber weiter wichtig. NOTARZT 2022. [DOI: 10.1055/a-1961-9717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Andreas Bohn
- Berufsfeuerwehr, Stadt Münster, Munster, Deutschland
| | - Jonas Blumenstiel
- Abteilung Anästhesie, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Deutschland
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Jariwala P, Jadhav K, Khetan S. Allergic myocardial infarction (type III Kounis syndrome) secondary to mushroom ingestion: An unusual cause of very late stent thrombosis of saphenous venous graft and refractory no-reflow phenomenon. J Cardiol Cases 2022; 26:51-55. [DOI: 10.1016/j.jccase.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/31/2022] [Accepted: 02/19/2022] [Indexed: 10/18/2022] Open
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9
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Vu VH, Nguyen KD, Nguyen CD, Truong BQ. A Case of Kounis Syndrome Presenting as Coronary Artery Spasm Associated with Acetaminophen Infusion. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e934190. [PMID: 34807902 PMCID: PMC8628564 DOI: 10.12659/ajcr.934190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patient: Male, 38-year-old
Final Diagnosis: Myocardial Infarction
Symptoms: Chest discomfort • dyspnea • hypotension
Medication: —
Clinical Procedure: —
Specialty: Allergology • Cardiology
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Affiliation(s)
- Vu Hoang Vu
- Department of Interventional Cardiology, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Khang Duong Nguyen
- Department of Interventional Cardiology, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Chinh Duc Nguyen
- Department of Interventional Cardiology, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Binh Quang Truong
- Cardiovascular Center, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
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10
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Abstract
Acute coronary syndrome (ACS) in the setting of an allergic/immunologic reaction is known as Kounis syndrome. It is an underdiagnosed and underrecognized disease entity. One must keep a high index of suspicions when managing a patient presenting with cardiac as well as allergic symptoms. There are 3 main variants to the syndrome. Treating the allergic reaction may alleviate the pain; however, ACS guidelines should be followed if cardiac ischemia is present.
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11
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Suppa M, Marino L, Piccari P, Masselli G, Gradini R. Cardiac complications in a patient affected by systemic mastocytosis and primitive myelofibrosis: A case report. Clin Case Rep 2021; 9:e04972. [PMID: 34804526 PMCID: PMC8587177 DOI: 10.1002/ccr3.4972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/04/2021] [Indexed: 11/18/2022] Open
Abstract
Systemic mastocytosis with associated primitive myelofibrosis is a rare and complex disease with a difficult therapeutic management. The release of several inflammation mediators can trigger acute cardiovascular events.
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Affiliation(s)
- Marianna Suppa
- Emergency DepartmentUmberto I HospitalUniversity Sapienza of RomeRomeItaly
| | - Luca Marino
- Emergency DepartmentUmberto I HospitalUniversity Sapienza of RomeRomeItaly
- Mechanical and Aerospace DepartmentUniversity Sapienza of RomeRomeItaly
| | - Pietro Piccari
- Emergency DepartmentUmberto I HospitalUniversity Sapienza of RomeRomeItaly
| | - Gabriele Masselli
- Radiology DepartmentUmberto I HospitalUniversity Sapienza of RomeRomeItaly
| | - Roberto Gradini
- Department of Experimental MedicineUniversity Sapienza of RomeRomeItaly
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12
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Kounis Syndrome Secondary to Medicine-Induced Hypersensitivity. Case Rep Med 2021; 2021:4485754. [PMID: 34630571 PMCID: PMC8500773 DOI: 10.1155/2021/4485754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/18/2021] [Accepted: 09/24/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Kounis syndrome is the concurrence of an acute coronary syndrome (ACS) caused by coronary vasospasms, acute myocardial infarctions, or stent thromboses in case of allergic or hypersensitivity reactions. Kounis syndrome is mediated by mast cells that interact with macrophages and T-lymphocytes, causing degranulation and inflammation with cytokine release. It is a life-threatening condition that has many trigger factors and is most commonly caused by medicines. Case Presentation. A 71-year-old male was admitted with a fever of five days' duration associated with cellulitis, for which he had been treated with clindamycin and flucloxacillin before admission. He was a diagnosed patient with hypertension and dyslipidemia five years ago. After taking the antibiotics, he had developed generalized itching followed by urticaria suggesting an allergic reaction. Therefore, he was admitted to the hospital. After admission, he developed an ischaemic-type chest pain associated with autonomic symptoms and shortness of breath. An immediate ECG was taken that showed ST-segment depressions in the chest leads V4–V6, confirmed by a repeat ECG. Troponin I was 8 ng/mL. Acute management of ACS was started, and prednisolone 10 mg daily dose was given. After complete recovery, the patient was discharged with aspirin, clopidogrel, atorvastatin, metoprolol, losartan, isosorbide mononitrate, and nicorandil. Prednisolone 10 mg daily dose was given for five days after discharge. Conclusion In immediate hypersensitivity, with persistent cardiovascular instability, Kounis syndrome should be considered, and an electrocardiogram and other appropriate assessments and treatments should be initiated. Prompt management of the allergic reaction and the ACS is vital for a better outcome of Kounis syndrome.
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Lin L, Sandefur BJ, Campbell RL, Liu Z, Liu XW. Biphasic anaphylaxis manifested as type I Kounis syndrome induced by ingestion of raw fish gallbladder: A case report. World J Emerg Med 2021; 12:238-240. [PMID: 34141043 DOI: 10.5847/wjem.j.1920-8642.2021.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Long Lin
- Department of Emergency Medicine, the First Affiliated Hospital, China Medical University, Shenyang 110001, China
| | | | - Ronna L Campbell
- Department of Emergency Medicine, Mayo Clinic, Rochester 55905, USA
| | - Zhi Liu
- Department of Emergency Medicine, the First Affiliated Hospital, China Medical University, Shenyang 110001, China
| | - Xiao-Wei Liu
- Department of Emergency Medicine, the First Affiliated Hospital, China Medical University, Shenyang 110001, China
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Sessa M, Mascolo A, Dalhoff KP, Andersen M. The risk of fractures, acute myocardial infarction, atrial fibrillation and ventricular arrhythmia in geriatric patients exposed to promethazine. Expert Opin Drug Saf 2020; 19:349-357. [PMID: 31903798 DOI: 10.1080/14740338.2020.1711882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives: This study aimed to compare the risk of fractures, acute myocardial infarction, atrial fibrillation, and ventricular arrhythmia among Danish citizens aged ≥ 65 which were new users of promethazine or domperidone, triazolam, loratadine, and betahistine. Secondly, the study aimed to perform a risk stratification to identify the most relevant predictors for the study outcomes.Methods: The study period was 01/01/2015 to 31/12/2016. The data sources were the Danish registers. Each patient was followed for 90 days. A logistic regression model was used to compute the unadjusted and adjusted odds ratios (OR), and a conditional inference tree was used to identify the most relevant predictors for the study outcomes.Results: Promethazine had a higher risk of hospitalization for atrial fibrillation than loratadine and betahistine (OR 1.58; 95% CI 1.07-2.63 and OR 3.22; 95% CI 1.69-7.14, respectively). For fractures, acute myocardial infarction, and ventricular arrhythmia hospitalizations, no statistically significant differences were found among drugs under investigation. The medical history of cardiac arrhythmia (OR 4.14; 95% CI 2.94-5.78, p < 0.0001) was the most relevant predictor for atrial fibrillation hospitalizations.Conclusion: This study found an increased risk of atrial fibrillation hospitalization among promethazine users, and the risk was higher among patients with prior cardiac arrhythmia.
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Affiliation(s)
- Maurizio Sessa
- Department of Drug Design and Pharmacology, University of Copenhagen, København Ø, Denmark
| | - Annamaria Mascolo
- Campania Pharmacovigilance and Pharmacoepidemiology Regional Center, Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Kim Peder Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, København, Denmark
| | - Morten Andersen
- Department of Drug Design and Pharmacology, University of Copenhagen, København Ø, Denmark
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Epidemiology of acute coronary syndrome co-existent with allergic/hypersensitivity/anaphylactic reactions (Kounis syndrome) in the United States: A nationwide inpatient analysis. Int J Cardiol 2019; 292:35-38. [PMID: 31204069 DOI: 10.1016/j.ijcard.2019.06.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/24/2019] [Accepted: 06/01/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The nationwide epidemiological data on Kounis Syndrome (KS), still remains indistinct in the United States (US) after it was first reported in 1991. METHODS We assessed the prevalence of KS among patients primarily hospitalized for allergic/hypersensitivity/anaphylactic reactions. We then compared baseline demographics, comorbidities, and outcomes of KS with patients with only allergic/hypersensitivity/anaphylactic reactions using the National Inpatient Sample, 2007-2014. RESULTS The cohort comprised of 235,420 patients primarily hospitalized with allergy/hypersensitivity/anaphylactic reactions. Of these, 2616 [1.1%; 0.2% unstable angina, 0.2% ST-elevation myocardial infarction & 0.7% non-ST-elevation myocardial infarction] patients experienced ACS and were identified as having KS. Patients with KS were older (mean 65.9 ± 14.1 vs. 57.2 ± 17.8 yrs), more often White (71.1% vs. 58.6%), male (46.4% vs. 39.9%) and Medicare enrollees (58.9% vs. 41.5%) admitted non-electively (96.8% vs. 95.3%) as compared to non-KS group (p < 0.001). The hospitalizations with KS demonstrated higher all-cause in-hospital mortality (7.0% vs. 0.4%, p < 0.001), prolonged hospitalization stay (mean 5.8 ± 6.0 vs. 3.0 ± 3.9 days, p < 0.001), higher hospitalization charges ($52,656 vs. $20,487, p < 0.001) and more frequent transfers to other facilities. The rates of stroke (1.0% vs. 0.2%), arrhythmias (30.4% vs. 12.4%), venous thromboembolism (1.6% vs. 1.0%), and diagnostic and therapeutic coronary interventions were also found to be significantly higher in patients with KS (p < 0.05). Patients with KS had increased odds of in-hospital mortality [unadjusted OR: 18.52; 95% CI: 15.74-21.80, p < 0.001 & adjusted OR: 9.74, 95% CI: 8.08-11.76, p < 0.001] compared to non-KS group. CONCLUSIONS Overall US prevalence of KS among patients hospitalized for allergic/hypersensitivity/anaphylactic reactions is 1.1% with a subsequent all-cause inpatient mortality rate of 7.0%.
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Mohajeri M, Kovanen PT, Bianconi V, Pirro M, Cicero AFG, Sahebkar A. Mast cell tryptase - Marker and maker of cardiovascular diseases. Pharmacol Ther 2019; 199:91-110. [PMID: 30877022 DOI: 10.1016/j.pharmthera.2019.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/01/2019] [Indexed: 12/14/2022]
Abstract
Mast cells are tissue-resident cells, which have been proposed to participate in various inflammatory diseases, among them the cardiovascular diseases (CVDs). For mast cells to be able to contribute to an inflammatory process, they need to be activated to exocytose their cytoplasmic secretory granules. The granules contain a vast array of highly bioactive effector molecules, the neutral protease tryptase being the most abundant protein among them. The released tryptase may act locally in the inflamed cardiac or vascular tissue, so contributing directly to the pathogenesis of CVDs. Moreover, a fraction of the released tryptase reaches the systemic circulation, thereby serving as a biomarker of mast cell activation. Actually, increased levels of circulating tryptase have been found to associate with CVDs. Here we review the biological relevance of the circulating tryptase as a biomarker of mast cell activity in CVDs, with special emphasis on the relationship between activation of mast cells in their tissue microenvironments and the pathophysiological pathways of CVDs. Based on the available in vitro and in vivo studies, we highlight the potential molecular mechanisms by which tryptase may contribute to the pathogenesis of CVDs. Finally, the synthetic and natural inhibitors of tryptase are reviewed for their potential utility as therapeutic agents in CVDs.
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Affiliation(s)
- Mohammad Mohajeri
- Department of Medical Biotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Vanessa Bianconi
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Matteo Pirro
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Arrigo F G Cicero
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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19
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Wilcock A, Bahri R, Bulfone‐Paus S, Arkwright PD. Mast cell disorders: From infancy to maturity. Allergy 2019; 74:53-63. [PMID: 30390314 DOI: 10.1111/all.13657] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/23/2018] [Accepted: 10/31/2018] [Indexed: 12/14/2022]
Abstract
Mast cells are typically linked to immediate hypersensitivity and anaphylaxis. This review looks beyond this narrow role, focusing on how these cells have evolved and diversified via natural selection promoting serine protease gene duplication, augmenting their innate host defense function against helminths and snake envenomation. Plasticity of mast cell genes has come at a price. Somatic activating mutations in the mast cell growth factor KIT gene cause cutaneous mastocytosis in young children and systemic mastocytosis with a more guarded prognosis in adults who may also harbor other gene mutations with oncogenic potential as they age. Allelic TPSAB1 gene duplication associated with higher basal mast cell tryptase is possibly one of the commonest autosomal dominantly inherited multi-system diseases affecting the skin, gastrointestinal tract, circulation and musculoskeletal system. Mast cells are also establishing a new-found importance in severe asthma, and in remodeling of blood vessels in cancer and atherosclerotic vascular disease. Furthermore, recent evidence suggests that mast cells sense changes in oxygen tension, particularly in neonates, and that subsequent degranulation may contribute to common lung, eye, and brain diseases of prematurity classically associated with hypoxic insults. One hundred and forty years since Paul Ehrlich's initial description of "mastzellen," this review collates and highlights the complex and diverse roles that mast cells play in health and disease.
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Affiliation(s)
- Amy Wilcock
- Lydia Becker Institute of Immunology and Inflammation University of Manchester Manchester UK
| | - Rajia Bahri
- Lydia Becker Institute of Immunology and Inflammation University of Manchester Manchester UK
| | - Silvia Bulfone‐Paus
- Lydia Becker Institute of Immunology and Inflammation University of Manchester Manchester UK
| | - Peter D. Arkwright
- Lydia Becker Institute of Immunology and Inflammation University of Manchester Manchester UK
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20
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Answer to letter to the editor concerning “Beware of an allergic reaction in stented patients”. Therapie 2018; 73:365-366. [DOI: 10.1016/j.therap.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 12/14/2017] [Indexed: 11/17/2022]
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Hangouche AJE, Lamliki O, Oukerraj L, Dakka T, Doghmi N, Zarzur J, Cherti M. Kounis syndrome induced by oral intake of aspirin: case report and literature review. Pan Afr Med J 2018; 30:301. [PMID: 30637085 PMCID: PMC6320451 DOI: 10.11604/pamj.2018.30.301.14948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/18/2018] [Indexed: 01/23/2023] Open
Abstract
The Kounis-Zavras syndrome is defined as the coincidental occurrence of acute coronary events and hypersensitivity reactions following an allergic reaction including a mast-cell degranulation of vasospastic mediators. This report describes a case of Kounis-Zavras syndrome in the setting of aspirin-induced asthma also known as Samter-Beer triad combining nasal polyps, asthma, and aspirin allergy leading to vasospasm and myocardial infarction. All physicians should be aware of The Kounis syndrome and always keep that unique clinical entity in mind to recognize it promptly and direct the therapy at suppressing the allergic reaction.
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Affiliation(s)
- Abdelkader Jalil El Hangouche
- Department of Cardiology B, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco.,Exercise Physiology and Autonomic Nervous System Team "EPE-SNA", Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco.,Laboratory of Physiology, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaâdi University, Tangier, Morocco
| | - Ouiame Lamliki
- Department of Cardiology B, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Latifa Oukerraj
- Department of Cardiology B, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Taoufiq Dakka
- Exercise Physiology and Autonomic Nervous System Team "EPE-SNA", Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Nawal Doghmi
- Department of Cardiology B, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Jamila Zarzur
- Department of Cardiology B, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Mohammed Cherti
- Department of Cardiology B, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
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22
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Çakmak T, Çaltekin İ, Gökçen E, Savrun A, Yaşar E. Kounis syndrome due to hirudotherapy (leech therapy) in emergency department; a case report. Turk J Emerg Med 2018; 18:85-87. [PMID: 29922739 PMCID: PMC6005928 DOI: 10.1016/j.tjem.2017.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 12/25/2017] [Accepted: 12/26/2017] [Indexed: 11/24/2022] Open
Abstract
Kounis Syndrome is the development of acute coronary syndrome (ACS) because of allergic reactions; allergens, such as foods, insect venom, iodine contrast agent or drugs can cause this syndrome. Hirudotherapy (leech therapy) is increasingly used as a useful therapeutic option in a variety of medical and surgical procedures, and potential complications related to this therapy include Aeromonas species infections, bleeding, anemia and allergic reactions. Here, we present a patient diagnosed as Type 1 Kounis Syndrome after using hirudotherapy for her knee aches. 41-year-old woman admitted to emergency department with sudden onset of face edema, shortness of breath and chest pain complaints and diagnosed as an allergic reaction and anaphylaxis due to leech therapy. Kounis Syndrome should be considered in acute coronary syndrome patients who were admitted to emergency department with anaphylaxis clinic.
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Affiliation(s)
- Tolga Çakmak
- Department of Cardiology, Malatya Training and Research Hospital, Malatya, Turkey
| | - İbrahim Çaltekin
- Department of Emergency Medicine, Bozok University Faculty of Medicine, Yozgat, Turkey
| | - Emre Gökçen
- Department of Emergency Medicine, Malatya Training and Research Hospital, Malatya, Turkey
| | - Atakan Savrun
- Department of Emergency Medicine, Ordu University Faculty of Medicine, Ordu, Turkey
| | - Erdoğan Yaşar
- Department of Cardiology, Malatya Training and Research Hospital, Malatya, Turkey
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23
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Ibuprofen-induced Kounis syndrome with diffuse ST segment depression and atrial fibrillation. Anatol J Cardiol 2017; 18:380-381. [PMID: 29145229 PMCID: PMC5731298 DOI: 10.14744/anatoljcardiol.2017.8045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Villamil-Munévar PA, Sánchez-Solanilla LF. Síndrome de Kounis o angina alérgica. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2016.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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25
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Prevalence of cancer in Takotsubo cardiomyopathy: Short and long-term outcome. Int J Cardiol 2017; 238:159-165. [DOI: 10.1016/j.ijcard.2017.02.093] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 02/06/2017] [Accepted: 02/20/2017] [Indexed: 12/19/2022]
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26
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Mitsis A, Christodoulou E, Georgiou P. Coronary spasm secondary to cefuroxime injection, complicated with cardiogenic shock - a manifestation of Kounis syndrome: case report and literature review. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 7:624-630. [PMID: 28345355 DOI: 10.1177/2048872617701885] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Kounis syndrome is defined as the coincidental occurrence of an acute coronary syndrome with hypersensitivity reactions following an allergic event. The three reported variants of Kounis syndrome are vasospastic allergic angina, allergic myocardial infarction and stent thrombosis with occluding thrombus. The syndrome is caused by various inflammatory mediators. The pathophysiological characteristics of Kounis syndrome involve coronary artery spasm and/or atheromatous plaque erosion or rupture during an allergic reaction. Several causes have been described to induce Kounis syndrome, and their number is increasing rapidly. The haemodynamic effect of the syndrome complicated by cardiogenic shock seems to combine allergic shock with extensive peripheral vasodilation and myocardial suppression with the characteristics of cardiogenic shock. Treatment of Kounis syndrome is challenging because it needs management of both cardiac and allergic manifestation simultaneously. We present a case report of type I Kounis syndrome, with coronary spasm secondary to cefuroxime injection complicated with cardiogenic shock. A brief review of the literature on the various facets of this condition is also provided.
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Affiliation(s)
- Andreas Mitsis
- 1 Cardiology and Aortic Centre, Royal Brompton Hospital, UK
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27
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Woudstra L, Biesbroek PS, Emmens RW, Heymans S, Juffermans LJ, van Rossum AC, Niessen HWM, Krijnen PAJ. Lymphocytic myocarditis occurs with myocardial infarction and coincides with increased inflammation, hemorrhage and instability in coronary artery atherosclerotic plaques. Int J Cardiol 2017; 232:53-62. [PMID: 28087177 DOI: 10.1016/j.ijcard.2017.01.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/28/2016] [Accepted: 01/04/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Although lymphocytic myocarditis (LM) clinically can mimic myocardial infarction (MI), they are regarded as distinct clinical entities. However, we observed a high prevalence (32%) of recent MI in patients diagnosed post-mortem with LM. To investigate if LM changes coronary atherosclerotic plaque, we analyzed in autopsied hearts the inflammatory infiltrate and stability in coronary atherosclerotic lesions in patients with LM and/or MI. METHODS The three main coronary arteries were isolated at autopsy of patients with LM, with MI of 3-6h old, with LM and MI of 3-6h old (LM+MI) and controls. In tissue sections of atherosclerotic plaque-containing coronary segments inflammatory infiltration, plaque stability, intraplaque hemorrhage and thrombi were determined via (immuno)histological criteria. RESULTS In tissue sections of those coronary segments the inflammatory infiltrate was found to be significantly increased in patients with LM, LM+MI and MI compared with controls. This inflammatory infiltrate consisted predominantly of macrophages and neutrophils in patients with only LM or MI, of lymphocytes in LM+MI and MI patients and of mast cells in LM+MI patients. Moreover, in LM+MI and MI patients this coincided with an increase of unstable plaques and thrombi. Finally, LM and especially MI and LM+MI patients showed significantly increased intraplaque hemorrhage. CONCLUSIONS This study demonstrates prevalent co-occurrence of LM with a very recent MI at autopsy. Moreover, LM was associated with remodeling and inflammation of atherosclerotic plaques indicative of plaque destabilization pointing to coronary spasm, suggesting that preexistent LM, or its causes, may facilitate the development of MI.
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Affiliation(s)
- Linde Woudstra
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; ICaR-VU, Institute for Cardiovascular Research, VU University Medical Center, The Netherlands.
| | - P Stefan Biesbroek
- ICaR-VU, Institute for Cardiovascular Research, VU University Medical Center, The Netherlands; Department of Cardiology, VU University Medical Center, The Netherlands; ICIN, Inter-university Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Reindert W Emmens
- ICaR-VU, Institute for Cardiovascular Research, VU University Medical Center, The Netherlands
| | - Stephane Heymans
- Center for Heart Failure Research, Cardiovascular Research Institute Maastricht (CARIM), University Hospital Maastricht, Maastricht, The Netherlands
| | - Lynda J Juffermans
- ICaR-VU, Institute for Cardiovascular Research, VU University Medical Center, The Netherlands; Department of Cardiology, VU University Medical Center, The Netherlands
| | - Albert C van Rossum
- ICaR-VU, Institute for Cardiovascular Research, VU University Medical Center, The Netherlands; Department of Cardiology, VU University Medical Center, The Netherlands
| | - Hans W M Niessen
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; ICaR-VU, Institute for Cardiovascular Research, VU University Medical Center, The Netherlands; Department of Cardiothoracic Surgery, VU University Medical Center, The Netherlands
| | - Paul A J Krijnen
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; ICaR-VU, Institute for Cardiovascular Research, VU University Medical Center, The Netherlands
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Salouage I, El Aidli S, Kastalli S, Daghfous R, Lakhal M. Fatal Kounis syndrome with stent thrombosis secondary to amoxicillin/clavulanic acid use: A case report and literature review. Therapie 2016; 71:535-539. [PMID: 27692979 DOI: 10.1016/j.therap.2016.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/24/2016] [Indexed: 12/23/2022]
Abstract
Anaphylactic reactions are often induced by drugs, and the most frequent ones are penicillin derivates. The concurrence of acute coronary syndrome with hypersensitivity and anaphylactic or anaphylactoid reactions constitutes the Kounis syndrome. We report a case of a coronary stent thrombosis with a fatal outcome complicating an anaphylactic shock induced by amoxicillin-clavulanic acid association. A 58-year-old woman with a history of triple coronary stenting was treated by amoxicillin/clavulanic acid association for pharyngitis. One hour after the first drug intake, she developed an anaphylactic shock with acute constricting chest pain. She received intravenous hydrocortisone and was transferred to emergency department. The patient received epinephrine intravenously with fluid perfusion and oxygen. Electrocardiogram showed Pardee waves in the anterior precordial leads. Cardiac enzyme levels (troponin I) were disturbed. The patient was transferred to the coronary care unit with a diagnosis of acute myocardial infarction. The coronary angiography revealed anterior interventricular stent thrombosis. The patient experienced a cardiogenic shock with an important hemodynamic repercussion, and she died few hours later despite emergency care. The responsibility of amoxicillin-clavulanic acid association was retained in the genesis of this anaphylactic shock in front of a suggestive delay, a compatible evolution and a high semiotic score. Amoxicillin/clavulanic acid use may cause Kounis syndrome. The use of epinephrine is a challenging decision. We suggest that Kounis syndrome should be considered in the differential diagnosis of acute coronary syndrome.
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Affiliation(s)
- Issam Salouage
- Centre national de pharmacovigilance, 9, rue Dr Zouhaier-Essafi, 1006 Tunis, Tunisia.
| | - Sihem El Aidli
- Centre national de pharmacovigilance, 9, rue Dr Zouhaier-Essafi, 1006 Tunis, Tunisia
| | - Sarra Kastalli
- Centre national de pharmacovigilance, 9, rue Dr Zouhaier-Essafi, 1006 Tunis, Tunisia
| | - Riadh Daghfous
- Centre national de pharmacovigilance, 9, rue Dr Zouhaier-Essafi, 1006 Tunis, Tunisia
| | - Mohamed Lakhal
- Centre national de pharmacovigilance, 9, rue Dr Zouhaier-Essafi, 1006 Tunis, Tunisia
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29
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Kolck UW, Haenisch B, Molderings GJ. Cardiovascular symptoms in patients with systemic mast cell activation disease. Transl Res 2016; 174:23-32.e1. [PMID: 26775802 DOI: 10.1016/j.trsl.2015.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/11/2015] [Accepted: 12/18/2015] [Indexed: 12/23/2022]
Abstract
Traditionally, mast cell activation disease (MCAD) has been considered as just one rare (neoplastic) disease, mastocytosis, focused on the mast cell (MC) mediators tryptase and histamine and the suggestive, blatant symptoms of flushing and anaphylaxis. Recently another form of MCAD, the MC activation syndrome, has been recognized featuring inappropriate MC activation with little to no neoplasia and likely much more heterogeneously clonal and far more prevalent than mastocytosis. Increasing expertise and appreciation has been established for the truly very large menagerie of MC mediators and their complex patterns of release, engendering complex, nebulous presentations of chronic and acute illness best characterized as multisystem polymorbidity of generally inflammatory ± allergic theme. We describe the pathogenesis of MCAD with a particular focus on clinical cardiovascular symptoms and the therapeutic options for MC mediator-induced cardiovascular symptoms.
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Affiliation(s)
- Ulrich W Kolck
- Johanniter-Kliniken Bonn, Waldkrankenhaus, Innere Medizin II, Bonn, Germany
| | - Britta Haenisch
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
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30
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Kupreishvili K, Fuijkschot WW, Vonk ABA, Smulders YM, Stooker W, Van Hinsbergh VWM, Niessen HWM, Krijnen PAJ. Mast cells are increased in the media of coronary lesions in patients with myocardial infarction and may favor atherosclerotic plaque instability. J Cardiol 2016; 69:548-554. [PMID: 27288329 DOI: 10.1016/j.jjcc.2016.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/26/2016] [Accepted: 04/29/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Mast cells (MCs) may play an important role in plaque destabilization and atherosclerotic coronary complications. Here, we have studied the presence of MCs in the intima and media of unstable and stable coronary lesions at different time points after myocardial infarction (MI). METHODS Coronary arteries were obtained at autopsy from patients with acute MI (up to 5 days old; n=27) and with chronic MI (5-14 days old; n=18), as well as sections from controls without cardiac disease (n=10). Herein, tryptase-positive MCs were quantified in the intima and media of both unstable and stable atherosclerotic plaques in infarct-related and non-infarct-related coronary arteries. RESULTS In the media of both acute and chronic MI patients, the number of MCs was significantly higher than in controls. This was also found when evaluating unstable and stable plaques separately. In patients with chronic MI, the number of MCs in unstable lesions was significantly higher than in stable lesions. This coincided with a significant increase in the relative number of unstable plaques in patients with chronic MI compared with control and acute MI. No differences in MC density were found between infarct-related and non-infarct-related coronary arteries in patients with MI. CONCLUSION The presence of MCs in the media of both stable and unstable atherosclerotic coronary lesions after MI suggests that MCs may be involved in the onset of MI and, on the other hand, that MI triggers intra-plaque infiltration of MCs especially in unstable plaques, possibly increasing the risk of re-infarction.
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Affiliation(s)
- Koba Kupreishvili
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Wessel W Fuijkschot
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands; Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Alexander B A Vonk
- Department of Cardiac Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Yvo M Smulders
- Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands; Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Wim Stooker
- Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands; Department of Cardiac Surgery, OLVG, Amsterdam, The Netherlands
| | - Victor W M Van Hinsbergh
- Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands; Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Hans W M Niessen
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands; Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Paul A J Krijnen
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands.
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31
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Mullins RJ, Wainstein BK, Barnes EH, Liew WK, Campbell DE. Increases in anaphylaxis fatalities in Australia from 1997 to 2013. Clin Exp Allergy 2016; 46:1099-110. [DOI: 10.1111/cea.12748] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/26/2016] [Accepted: 04/29/2016] [Indexed: 12/12/2022]
Affiliation(s)
- R. J. Mullins
- John James Medical Centre; Deakin ACT Australia
- Medical School; Australian National University; Canberra ACT Australia
| | - B. K. Wainstein
- Sydney Children's Hospital; Sydney NSW Australia
- School of Women's and Children's Health; University of New South Wales; Sydney NSW Australia
| | - E. H. Barnes
- NHMRC Clinical Trials Centre; University of Sydney; Sydney NSW Australia
| | - W. K. Liew
- SBCC Baby and Child Clinic; Gleneagles Medical Centre; Singapore Singapore
| | - D. E. Campbell
- Children's Hospital Westmead; Sydney NSW Australia
- Discipline of Paediatrics and Child Health; University of Sydney; Sydney NSW Australia
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Fassio F, Losappio L, Antolin-Amerigo D, Peveri S, Pala G, Preziosi D, Massaro I, Giuliani G, Gasperini C, Caminati M, Heffler E. Kounis syndrome: A concise review with focus on management. Eur J Intern Med 2016; 30:7-10. [PMID: 26795552 DOI: 10.1016/j.ejim.2015.12.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 12/07/2015] [Accepted: 12/13/2015] [Indexed: 01/02/2023]
Abstract
Kounis syndrome is defined as the co-incidental occurrence of an acute coronary syndrome with hypersensitivity reactions following an allergenic event and was first described by Kounis and Zavras in 1991 as an allergic angina syndrome. Multiple causes have been described and most of the data in the literature are derived from the description of clinical cases - mostly in adult patients - and the pathophysiology remains only partly explained. Three different variants of Kounis syndrome have been defined: type I (without coronary disease) is defined as chest pain during an acute allergic reaction in patients without risk factors or coronary lesions in which the allergic event induces coronary spasm that electrocardiographic changes secondary to ischemia; type II (with coronary disease) includes patients with pre-existing atheromatous disease, either previously quiescent or symptomatic, in whom acute hypersensitive reactions cause plaque erosion or rupture, culminating in acute myocardial infarction; more recently a type-III variant of Kounis syndrome has been defined in patients with preexisting coronary disease and drug eluting coronary stent thrombosis. The pathogenesis of the syndrome is discussed, and a therapeutic algorithm is proposed.
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Affiliation(s)
- Filippo Fassio
- UO Medicina, Ospedale San Jacopo, ASL3 Pistoia, Via Ciliegiole, 97, 51100 Pistoia, Italy.
| | - Laura Losappio
- University of Foggia, Viale Pinto, 1, 71121 Foggia, Italy.
| | - Dario Antolin-Amerigo
- Servicio de Enfermedades del Sistema Inmune-Alergia, Hospital Principe de Asturias, Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Carretera Alcalá, Meco, s/n, 28805 Alcalá de Henares, Madrid, Spain.
| | - Silvia Peveri
- U.O.s.D. Allergologia, Ospedale Guglielmo Da Saliceto, Via Campagna, 68, Piacenza, Italy.
| | - Gianni Pala
- Servizio del Medico Competente, Azienda Sanitaria Locale di Sassari, via Catalocchino 11, 07100 Sassari, Italy.
| | - Donatella Preziosi
- IRCCS Policlinico San Donato, Piazza Edmondo Malan, 1, 20097 San Donato Milanese (MI), Italy.
| | - Ilaria Massaro
- Centro di Ricerca, Trasferimento ed Alta Formazione Denothe, Università di Firenze, Viale Pieraccini, 6, Firenze, Italy.
| | - Gabriele Giuliani
- UO Cardiologia, Ospedale San Giovanni di Dio, via di Torregalli 3, 50143 Firenze, Italy.
| | - Chiara Gasperini
- UO Anestesia e Rianimazione, Ospedale San Jacopo, ASL3 Pistoia, Via Ciliegiole, 97, 51100 Pistoia, Italy.
| | - Marco Caminati
- UO Allergologia, Azienda Ospedaliero Universitaria Integrata, Piazzale Aristide Stefani, 1, Verona, Italy.
| | - Enrico Heffler
- Dipartimento di Medicina Clinica e Sperimentale, Pneumologia Riabilitativa e Allergologia, Università degli Studi di Catania, Via Santa Sofia 78, 95126 Catania, Italy.
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Voloshyna I, Mucci T, Sher J, Fonacier LS, Littlefield MJ, Carsons S, Reiss AB. Plasma IL-33 in atopic patients correlates with pro-inflammatory cytokines and changes cholesterol transport protein expression: a surprising neutral overall impact on atherogenicity. Clin Exp Allergy 2015; 45:1554-65. [DOI: 10.1111/cea.12516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Indexed: 12/12/2022]
Affiliation(s)
- I. Voloshyna
- Department of Medicine; Winthrop University Hospital; Mineola NY USA
- Winthrop Research Institute; Winthrop University Hospital; Mineola NY USA
| | - T. Mucci
- Department of Medicine; Winthrop University Hospital; Mineola NY USA
| | - J. Sher
- Department of Medicine; Winthrop University Hospital; Mineola NY USA
| | - L. S. Fonacier
- Department of Medicine; Winthrop University Hospital; Mineola NY USA
| | - M. J. Littlefield
- Department of Medicine; Winthrop University Hospital; Mineola NY USA
- Winthrop Research Institute; Winthrop University Hospital; Mineola NY USA
| | - S. Carsons
- Department of Medicine; Winthrop University Hospital; Mineola NY USA
- Winthrop Research Institute; Winthrop University Hospital; Mineola NY USA
| | - A. B. Reiss
- Department of Medicine; Winthrop University Hospital; Mineola NY USA
- Winthrop Research Institute; Winthrop University Hospital; Mineola NY USA
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Weiss GM, Fandrick AD, Sidebotham D. Successful Rescue of an Adult With Refractory Anaphylactic Shock and Abdominal Compartment Syndrome With Venoarterial Extracorporeal Membrane Oxygenation and Bedside Laparotomy. Semin Cardiothorac Vasc Anesth 2014; 19:66-70. [DOI: 10.1177/1089253214564192] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The incidence of life-threatening anaphylactic reactions related to anesthesia is approximately 1 in 6000 anesthetics administered, and is associated with mortality as high as 5%. In such cases the use of extracorporeal membrane oxygenation (ECMO) in the setting of refractory shock following anaphylaxis may be life saving. Abdominal compartment syndrome (ACS) itself and in this case complicating ECMO support, is a potentially devastating complication of high-volume resuscitation. Decompressive laparotomy is the treatment of choice for ACS. We present a patient treated with venoarterial ECMO for refractory shock following anaphylaxis who developed ACS that was successfully treated with urgent decompressive laparotomy performed in the intensive care unit. This case report highlights the role of abdominal compartment syndrome as a rare but potentially fatal cause of low circuit flow in ECMO-supported patients and proposes a stepwise approach to decision making in this setting. Urgent decompressive laparotomy is potentially lifesaving in this circumstance, and should be urgently considered once other causes of low ECMO flow have been excluded.
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35
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Günaydın ZY, Bektaş O, Akgedik R, Kaya A, Acar T. Recurrent Kounis syndrome. How should be the long-term treatment of Kounis syndrome? Int J Cardiol 2014; 177:1042-3. [PMID: 25465832 DOI: 10.1016/j.ijcard.2014.11.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 11/05/2014] [Indexed: 12/23/2022]
Affiliation(s)
| | - Osman Bektaş
- Ordu University, Department of Cardiology, Ordu, Turkey
| | - Recep Akgedik
- Ordu University, Department of Chest Diseases, Ordu, Turkey
| | - Ahmet Kaya
- Ordu University, Department of Cardiology, Ordu, Turkey
| | - Tarık Acar
- Ordu University, Department of Emergency Medicine, Ordu, Turkey
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36
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Velasco E, Díaz E, Avanzas P, Rubín JM. Acute stent thrombosis due to Kounis syndrome. Int J Cardiol 2014; 177:698-700. [PMID: 25449487 DOI: 10.1016/j.ijcard.2014.09.146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 09/27/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Elena Velasco
- Hospital Universitario Central de Asturias, Department of Cardiology, Avd. Hospital Central de Asturias, sn 33011 Oviedo, Spain.
| | - Elena Díaz
- Hospital Universitario Central de Asturias, Department of Cardiology, Avd. Hospital Central de Asturias, sn 33011 Oviedo, Spain
| | - Pablo Avanzas
- Hospital Universitario Central de Asturias, Department of Cardiology, Avd. Hospital Central de Asturias, sn 33011 Oviedo, Spain
| | - José M Rubín
- Hospital Universitario Central de Asturias, Department of Cardiology, Avd. Hospital Central de Asturias, sn 33011 Oviedo, Spain
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Rupatadine for the treatment of allergic rhinitis and urticaria: a look at the clinical data. ACTA ACUST UNITED AC 2014. [DOI: 10.4155/cli.14.26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cardillo MT, Della Bona R, Basile E, Marano R, Biasucci LM. Hypersensitivity myocarditis or Kounis syndrome? Intern Emerg Med 2014; 9:247-8. [PMID: 23754271 DOI: 10.1007/s11739-013-0965-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 05/28/2013] [Indexed: 12/16/2022]
Affiliation(s)
- Maria Teresa Cardillo
- Institute of Cardiology, Catholic University of the Sacred Heart, L.go Gemelli, 8, 00168, Rome, Italy
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Michaud K, Grabherr S, Shiferaw K, Doenz F, Augsburger M, Mangin P. Acute coronary syndrome after levamisole-adultered cocaine abuse. J Forensic Leg Med 2014; 21:48-52. [DOI: 10.1016/j.jflm.2013.10.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 09/28/2013] [Accepted: 10/27/2013] [Indexed: 12/17/2022]
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Ridolo E, Triggiani M, Montagni M, Olivieri E, Ticinesi A, Nouvenne A, Magliacane D, de Crescenzo G, Meschi T. Mastocytosis presenting as cardiac emergency. Intern Emerg Med 2013; 8:749-52. [PMID: 24136074 DOI: 10.1007/s11739-013-1012-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 10/07/2013] [Indexed: 12/18/2022]
Abstract
Mastocytosis is characterised by clonal proliferation of mast cells in the skin and in various internal organs, and by symptoms related to an acute release of mast cell-derived mediators. In 20-30 % of patients, mastocytosis occurs without the typical skin lesions of urticaria pigmentosa that are usually the first clinical sign of the disease. In these patients, anaphylaxis is often the presenting sign of the disease. We report three cases in which a cardiac emergency (cardiac arrest or ventricular fibrillation) was the first clinical manifestation of anaphylaxis associated with systemic mastocytosis. All patients were men, none of them had previous episodes of anaphylaxis or other mediator-related symptoms, and none had major pre-existing cardiovascular condition. An eliciting factor was identified in one case (a wasp sting), but one was found in the other two. Elevation of the serum tryptase suggested a mastocytosis, which was confirmed by bone marrow biopsy. This case series demonstrates that cardiovascular emergencies may be presenting signs of mastocytosis, and that elevation of serum tryptase after an acute cardiac event, if confirmed under basal conditions, may be useful for diagnosing this disease.
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Affiliation(s)
- Erminia Ridolo
- Department of Clinical and Experimental Medicine, University of Parma, via Gramsci 14, 43100, Parma, Italy,
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Correale M, Santoro F, Ieva R, Di Biase M, Brunetti ND. Tako-Tsubo cardiomyopathy or allergic acute coronary syndrome: that is the question. Intern Emerg Med 2013; 8:639. [PMID: 23612895 DOI: 10.1007/s11739-013-0942-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 04/11/2013] [Indexed: 12/28/2022]
Affiliation(s)
- Michele Correale
- Department of Cardiology, "Ospedali Riuniti"OO.RR, University of Foggia, viale L Pinto, 1, 71100, Foggia, Italy,
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Fassio F, Almerigogna F. Tako-Tsubo cardiomyopathy or Kounis syndrome: finding differences and similarities to answer the question. Intern Emerg Med 2013; 8:637-8. [PMID: 23612894 DOI: 10.1007/s11739-013-0932-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 03/02/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Filippo Fassio
- Immunology and Cell Therapies Unit, Department of Biomedicine, AOU Careggi, Florence, Italy,
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Akgullu C, Eryilmaz U, Gungor H, Zencir C, Selvi M, Avcil M, Dagli B. Myocardial infarction secondary to morphine-induced Kounis syndrome. Herz 2013; 39:874-6. [PMID: 23907697 DOI: 10.1007/s00059-013-3919-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 07/06/2013] [Indexed: 12/16/2022]
Affiliation(s)
- C Akgullu
- Faculty of Medicine, Department of Cardiology, Adnan Menderes University , 09100, Aydin, Turkey
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Campo G, Pavasini R, Pollina A, Petrini L, Ferrari R. Kounis-Zavras syndrome presenting with ventricular arrhythmias and cardiogenic shock. J Cardiol Cases 2012; 7:e74-e77. [PMID: 30533127 DOI: 10.1016/j.jccase.2012.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 10/15/2012] [Accepted: 11/03/2012] [Indexed: 12/15/2022] Open
Abstract
In this case report we describe a case of the Kounis-Zavras syndrome (coincidental occurrence of chest pain and allergic reactions accompanied by clinical and laboratory findings of cardiac ischemia). A 34-year-old woman presented to the emergency unit with severe chest pain from 2 h. She reported a medical history of asthma. On arrival, her heart rate was 125 beats/min and her systolic blood pressure (SBP) was 70 mmHg. A repeated electrocardiogram displayed dynamic changes with ST-segment elevation in D1-aVL leads and ST-segment depression in infero-posterior leads. Two episodes of ventricular fibrillation were observed. The coronary artery angiography showed multivessel coronary vasospasms. Intracoronary nitroglycerin was used to alleviate the coronary vasospasms. Contemporaneously, the patient's husband came to the hospital reporting a history of ketorolac consumption some hours before the onset of the acute event for headache symptoms. This crucial information permitted us to suppose it was a case of allergic myocardial infarction during anaphylactic shock due to ketorolac. Betametasone, chlorphenamine, and ranitidine were administered and progressively a full recovery of SBP and of clinical status was observed. <Learning objective: Allergic myocardial infarction (Kounis-Zavras syndrome) is a complex acute coronary syndrome which requires rapid treatment decisions. Most of the information on this syndrome comes from case reports or small case series. It should be considered in young, healthy patients when they develop acute coronary syndrome after administration of potentially allergic agent. The treatment should both dilate coronary vessels and suppress the allergic reaction (steroids, antihistamines, fluid resuscitation, oxygen, nitrates, calcium channel blockers).>.
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Affiliation(s)
- Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria S. Anna di Ferrara, Ferrara, Italy
- LTTA Center, Ferrara, Italy
| | - Rita Pavasini
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria S. Anna di Ferrara, Ferrara, Italy
- LTTA Center, Ferrara, Italy
| | - Alberto Pollina
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria S. Anna di Ferrara, Ferrara, Italy
- LTTA Center, Ferrara, Italy
| | - Laura Petrini
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria S. Anna di Ferrara, Ferrara, Italy
- LTTA Center, Ferrara, Italy
| | - Roberto Ferrari
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria S. Anna di Ferrara, Ferrara, Italy
- LTTA Center, Ferrara, Italy
- Cardiovascular Research Centre, Salvatore Maugeri Foundation, IRCCS, Lumezzane (BS), Italy
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Yurtdaş M, Aydin MK. A case of coronary spasm with resultant acute myocardial infarction: likely the result of an allergic reaction. Intern Med 2012; 51:2161-4. [PMID: 22892496 DOI: 10.2169/internalmedicine.51.7852] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Kounis syndrome has been known as allergenic angina and/or allergenic myocardial infarction following an allergic reaction. Probable allergic insults usually include drugs, latex, and food. Although ceftriaxone administration has been associated with various allergic reactions such as urticaria, angioedema, erythema, rash and anaphylactic shock, as far as we know, there is no published report that has shown an association between ceftriaxone use and Kounis syndrome. Here, we describe the first report of allergic vasospasm, culminating in acute inferior myocardial infarction, probably as the result of an acute allergenic reaction, after ceftriaxone use.
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