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Youcefi HE, Abu Saadeh A, Karaca G, Kimiaei A, Safaei S, Kaya A. Exploring Variations in Etiology and Clinical Presentations of Kounis Syndrome Across Pediatric and Adult Populations: A Comprehensive Review. Cureus 2024; 16:e56249. [PMID: 38623099 PMCID: PMC11016985 DOI: 10.7759/cureus.56249] [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] [Accepted: 03/15/2024] [Indexed: 04/17/2024] Open
Abstract
Kounis syndrome (KS), recognized as a rare yet significant form of acute coronary syndrome precipitated by allergy-mediated mechanisms, poses diagnostic challenges due to its varied clinical presentations and under-recognition. Despite its relevance across diverse populations, comprehensive insights into age-specific characteristics and management remain limited. The analysis of 420 studies yielded a total of 466 case reports of Kounis syndrome, categorized into pediatric (n = 31) and adult (n = 435) populations. After rigorous screening, 330 adult and 20 pediatric case reports were included for further analysis. Triggering factors were identified, with drugs (other) being the most prevalent in both groups. The breakdown of triggering factors, such as drugs (antibiotics), bee/wasp stings, and contrast media, was elucidated. Variations in presenting symptoms, diagnostic investigations, and treatment modalities between pediatric and adult populations were observed. Notably, all pediatric cases were diagnosed with subtype I Kounis syndrome and demonstrated favorable outcomes without any reported fatalities, whereas adult cases exhibited a broader range of Kounis subtypes. Mortality was recorded solely in adult case reports, with no fatalities reported among pediatric cases. These findings underscore the importance of understanding the nuances in the clinical presentation and management of Kounis syndrome across different age groups.
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Affiliation(s)
| | | | | | - Ali Kimiaei
- Cardiology, Bahçeşehir University, Istanbul, TUR
| | | | - Adnan Kaya
- Cardiology, Bahçeşehir University, Istanbul, TUR
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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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Wang C, Deng Z, Song L, Sun W, Fang W, Li Z. Analysis of clinical characteristics of Kounis syndrome induced by contrast media. Am J Emerg Med 2021; 52:203-207. [PMID: 34959022 DOI: 10.1016/j.ajem.2021.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Understanding the relationship between contrast agents and Kounis syndrome (KS) is mainly based on case reports. The purpose of this research is to explore the clinical characteristics of contrast media induced KS. METHODS We searched for contrast-induced KS case reports through Chinese and English databases from 1991 to October 31, 2021. RESULTS A total of 26 patients (19 men and 7 women,) were included, with a median age of 60 years (range 30-83). The contrast agents that cause KS mainly included gadolinium-based contrast agent (7 cases), iodine-containing contrast media (12 cases). KS mainly occurred within 30 min after administration and mainly manifests as chest pain and allergic reactions. Electrocardiogram (ECG) mainly showed ST elevation. Echocardiography mainly revealed normal. Coronary angiography showed normal, coronary vasospasm, stent thrombosis, occlusion and stenosis. After treatment with steroids, antihistamines and anti-ischemic therapy, 24 patients recovered completely and 2 patients died. CONCLUSIONS KS is a rare adverse reaction of contrast media. Radiologists should recognize this rare but serious disease to ensure rapid diagnosis and proper management.
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Affiliation(s)
- Chunjiang Wang
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhenzhen Deng
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Liying Song
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Wei Sun
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Weijin Fang
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zuojun Li
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China.
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Shibuya K, Kasama S, Funada R, Katoh H, Tsushima Y. Kounis syndrome induced by contrast media: A case report and review of literature. Eur J Radiol Open 2019; 6:91-96. [PMID: 30805421 PMCID: PMC6374503 DOI: 10.1016/j.ejro.2019.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 12/21/2022] Open
Abstract
Kounis syndrome (KS) is an acute coronary disorder associated with anaphylactic reactions. The purpose of this report is to identify the features of KS triggered by contrast media on the basis of our experience and from literature review. We have described a case and literature review of KS triggered by injection of contrast media. Including the present case, we reviewed eleven cases of KS. Six cases developed KS in diagnostic radiology departments. KS could be induced by intravenous injection of contrast media in the radiology department. Radiologists should recognize this critical condition to ensure appropriate management.
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Affiliation(s)
- Kei Shibuya
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan.,Gunma University Heavy Ion Medical Center, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Shu Kasama
- Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Ryuichi Funada
- Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Hiroyuki Katoh
- Gunma University Heavy Ion Medical Center, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Yoshito Tsushima
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
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Moreno E, Gracia-Bara MT, Mayorga C, Lázaro M, Campanón MV, Dávila I. Hypersensitivity Reactions to Iodinated Contrast Media: Is it a True Allergy? CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0154-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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The utility of cardiac magnetic resonance imaging in Kounis syndrome. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:218-23. [PMID: 26677363 PMCID: PMC4631737 DOI: 10.5114/pwki.2015.54017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/01/2014] [Accepted: 06/12/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Current diagnostic measurements used to assess myocardial involvement in Kounis syndrome, such as electrocardiography (ECG), cardiac enzymes, and troponin levels, are relatively insensitive to small but potentially significant functional change. According to our review of the literature, there has been no study using magnetic resonance imaging (MRI) on Kounis syndrome except for one case report. Aim To identify the findings of dynamic contrast-enhanced magnetic resonance imaging (CE-MRI) in patients with Kounis syndrome (KS) type 1. Material and methods We studied 26 patients (35 ±11.5 years, 53.8% male) with known or suspected KS type 1. The patients underwent precontrast, first-pass, and delayed enhancement cardiac MRI (DE-MRI). Contrast enhancement patterns, edema, hypokinesia, and localization for myocardial lesions were evaluated in all KS type 1 patients. Results Contrast-enhanced magnetic resonance imaging demonstrated an early-phase subendocardial contrast defect, and T2-weighted images showed high-signal intensity consistent with edema in lesion areas. None of the lesion areas was found upon contrast enhancement on DE-MRI. The area of early-phase subendocardial contrast defect was reported as follows: the interventricular septum in 14 (53.8%) patients, the left ventricular lateral wall in 8 (30.7%), and the left ventricular apex in 4 (15.4%). Conclusions Dynamic cardiac MR imaging is a reliable tool for assessing cardiac involvement in Kounis syndrome. Delayed contrast-enhanced images show normal washout in the subendocardial lesion area in patients with Kounis syndrome type 1.
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Esber C, Breathett K, Sachak T, Moore S, Lilly SM. Acute Myocardial Infarction in Patient With Triple Negative Breast Cancer After Paclitaxel Infusion: A Case Report. Cardiol Res 2014; 5:108-111. [PMID: 28348706 PMCID: PMC5358171 DOI: 10.14740/cr325w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2014] [Indexed: 11/11/2022] Open
Abstract
A 47-year-old woman with breast cancer suffered progressive chest pain and flushing within 5 minutes of her second exposure to paclitaxel. Her symptoms progressed and she became pulseless. Advanced cardiac life support (ACLS) was initiated, and after a series of chest compressions the cardiac monitor revealed ventricular fibrillation. With ongoing ACLS she was transferred to the emergency department where she regained a pulse. Review of electrocardiogram revealed prominent ST elevation in leads V1, V2 and V3 with reciprocal ST depression. She was transferred urgently to the catheterization laboratory. Angiography revealed a high-grade stenosis in the proximal left anterior descending artery (LAD), and drug-eluting stents were placed without complications. She was then transferred to the floor and shortly thereafter suffered pulseless electrical activity and died despite prolonged attempts at resuscitation. Herein, we describe the development of acute myocardial infarction after paclitaxel administration, discuss potential etiologies and review evidence for an allergic component.
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Affiliation(s)
- Christopher Esber
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Khadijah Breathett
- Department of Internal Medicine, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Taha Sachak
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stephen Moore
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Scott M Lilly
- Department of Internal Medicine, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Akoz A, Bayramoglu A, Uzkeser M, Kantarci M, Aksakal E, Emet M. Two questions for Kounis syndrome: can we use magnetic resonance imaging in the diagnosis and does ST elevation correlates with troponin levels? Am J Emerg Med 2012; 30:2086.e5-7. [PMID: 22386343 DOI: 10.1016/j.ajem.2011.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 12/09/2011] [Indexed: 10/28/2022] Open
Abstract
Kounis syndrome (KS) is an acute coronary vasospasm after exposure to an allergen due to mast cell degranulation and existing mediators. Various drugs, conditions, and environmental exposures can cause KS. We presented 2 cases, 1 of whom had taken an antiflu drug (containing paracetamol, pseudoephedrine, and dextromethorphan). His electrocardiogram (ECG) showed inferior ST elevations (2 mm) with normal cardiac biomarkers. His cardiac magnetic resonance imaging showed hypokinesis and myocardial hibernation on apical septum and on the left ventricle. The second patient took a pill of naproxen sodium. The ECG showed 1-mm ST elevation in leads DII, V5, and V6. His troponin was markedly elevated. These cases showed that there seems to be no correlation with ECG and troponin levels in KS. In addition, for patients in whom KS type 1 is expected without troponin elevation, noninvasive cardiac magnetic resonance imaging study seems to be appropriate for the diagnosis of KS.
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Affiliation(s)
- Ayhan Akoz
- Department of Emergency Medicine, Ataturk University Medical Faculty, 25240 Erzurum, Turkey.
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