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Shrestha G, Dhungana R, Neupane A, Pokharel A, Rajbhandari S. An ischemic complication of a snake bite: Case report. Int J Surg Case Rep 2023; 112:108962. [PMID: 37839257 PMCID: PMC10667865 DOI: 10.1016/j.ijscr.2023.108962] [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: 09/20/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Snakebite is a common type of animal bite injury worldwide. The local effect can manifest as an abscess followed by cellulitis and compartment syndrome which could cause ischemic tissue damage. CASE PRESENTATION A case of a 40-year male with a history of a snake bite 4 days back complained of swelling, throbbing pain, bluish discoloration of the skin and blackish discoloration of the little finger. Incision and drainage were done initially with disarticulation of the gangrenous little finger and finally treated with a split-thickness graft. CLINICAL DISCUSSION Snakebite can lead to only the bite mark without clinical features, local manifestations around the bite site, systemic toxicity due to redistribution of venom and signs and symptoms due to traditional treatment. Delayed presentation and improper treatment can lead to wound infection, abscess, compartment syndrome, necrotizing fasciitis and gangrene. CONCLUSION Snakebite is common in rural areas around the tropical world. Complications like compartment syndrome, necrotizing fasciitis and gangrene could develop following snake bite for which immediate surgical intervention is required to prevent loss of limb and life.
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Elgendy MM, Madkour SAG, Sheta AAEM, Hamouda EH, Ghitani SA. Kounis syndrome after anti-snake venom intradermal skin test: A case report. Toxicon 2023; 234:107281. [PMID: 37678580 DOI: 10.1016/j.toxicon.2023.107281] [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: 08/21/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/09/2023]
Abstract
Snake bites are a concerning health problem in Egypt and other tropical countries that are effectively managed with anti-snake venom (ASV). ASV has common reactive complications that are usually mild. Rarely, anaphylaxis and severe systemic reactions may occur following ASV. In this case report, we present a rare condition of Kounis syndrome, acute allergic myocardial infarction, in a young man during anaphylaxis following an allergic intradermal test of VACSERA snake antivenom.
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Affiliation(s)
- Mai Mohammad Elgendy
- Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Egypt.
| | | | | | - Emad Hamdy Hamouda
- Critical Care Medicine, Faculty of Medicine, Alexandria University, Egypt
| | - Sara Attia Ghitani
- Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Egypt
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3
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Wedasingha S, Sarathchandra C, Weerawansa P, Rathnasekara T, Karunarathna S, Isbister GK, Silva A. Kounis syndrome following an anaphylactic reaction to antivenom in a patient with Russell's viper (Daboia russelii) bite: A case report. Toxicon 2022; 218:66-69. [PMID: 36113684 DOI: 10.1016/j.toxicon.2022.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/30/2022] [Accepted: 09/08/2022] [Indexed: 11/18/2022]
Abstract
Kounis syndrome is the occurrence of acute coronary syndrome associated with mast cell and platelet activation in the setting of allergic or anaphylactic insults. Kounis syndrome has been previously reported following snake envenoming rarely, with or without antivenom therapy. We report a case of inferolateral ST elevation myocardial infarction 32 hours from a confirmed Russell's viper bite. He also had an anaphylactic reaction soon after antivenom. The absence of underlying atheromatous coronary artery disease during subsequent cardiac imaging was suggestive of a diagnosis of a type I variant of Kounis syndrome. Chest pain completely resolved by day 6 following initiation of standard treatment for acute coronary syndrome. Concurrence of allergic features and acute coronary syndrome in a snakebite patient following antivenom therapy should alert clinicians to the possibility of Kounis syndrome, which should be diagnosed with a high degree of clinical suspicion.
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Affiliation(s)
- Supun Wedasingha
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka
| | - Chamara Sarathchandra
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka
| | - Prasanna Weerawansa
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka
| | | | | | - Geoffrey K Isbister
- Clinical Toxicology Research Group, University of Newcastle, Newcastle, New South Wales, Australia
| | - Anjana Silva
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka.
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Li H, Li Y, Wu X. Acute myocardial infarction with no chest pain following a Trimeresurus stejnegeri snakebite: a case report. Am J Transl Res 2022; 14:4169-4175. [PMID: 35836840 PMCID: PMC9274599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
A 74-year-old female was bitten by a Trimeresurus stejnegeri, which is an unusual but dangerous type of snakebite. After the snakebite, the patient developed oedema, pain and numbness in the injured limb, and acute myocardial infarction, but no chest pain. The patient received base treatment, including anti-venom serum, statins and wound cleaning. After treatment, the pain in the injured limb disappeared and the swelling decreased. The patient underwent a coronary angiogram the next day, and severe stenosis of the anterior descending branch of the left coronary artery was found. She was given coronary stent implantation. After surgery, she was treated with anticoagulants, and antiplatelet medication and was discharged from the hospital on the sixth day after the condition improved. This case report of myocardial infarction-related snake envenomation aims to increase the awareness that snakebites may cause AMI and therefore, multidisciplinary management particularly from emergency physicians and cardiologists may be necessary.
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Affiliation(s)
- He Li
- Department of Emergency Medicine, Yulin First People’s Hospital (The Sixth Affiliated Hospital of Guangxi Medical University)Yulin 537000, Guangxi Zhuang Autonomous Region, China
| | - Yiyi Li
- Department of Cardiology, Yulin First People’s Hospital (The Sixth Affiliated Hospital of Guangxi Medical University)Yulin 537000, Guangxi Zhuang Autonomous Region, China
| | - Xianrong Wu
- Department of Emergency Medicine, Yulin First People’s Hospital (The Sixth Affiliated Hospital of Guangxi Medical University)Yulin 537000, Guangxi Zhuang Autonomous Region, China
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Review of the Mechanisms of Snake Venom Induced Pain: It's All about Location, Location, Location. Int J Mol Sci 2022; 23:ijms23042128. [PMID: 35216244 PMCID: PMC8879488 DOI: 10.3390/ijms23042128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 02/06/2023] Open
Abstract
Pain—acute, chronic and debilitating—is the most feared neurotoxicity resulting from a survivable venomous snake bite. The purpose of this review is to present in a novel paradigm what we know about the molecular mechanisms responsible for pain after envenomation. Progressing from known pain modulating peptides and enzymes, to tissue level interactions with venom resulting in pain, to organ system level pain syndromes, to geographical level distribution of pain syndromes, the present work demonstrates that understanding the mechanisms responsible for pain is dependent on “location, location, location”. It is our hope that this work can serve to inspire the molecular and epidemiologic investigations needed to better understand the neurotoxic mechanisms responsible for these snake venom mediated diverse pain syndromes and ultimately lead to agent specific treatments beyond anti-venom alone.
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Acute Myocardial Infarction (AMI) Treated with Snake Antivenom. Case Rep Emerg Med 2021; 2021:9945296. [PMID: 34697575 PMCID: PMC8541847 DOI: 10.1155/2021/9945296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/04/2021] [Indexed: 11/18/2022] Open
Abstract
Cardiac complications following snakebites are uncommon but fatal. Here, we discuss a case of a snakebite that led to acute myocardial infarction (AMI). Forty-five-year-old male presented to the emergency room with snakebite on the right middle finger. He was given symptomatic treatment and admitted for observation. His vital signs and initial investigations were normal except for the white blood count that was high. During observation, he developed vomiting and bradycardia. He was diagnosed with a right bundle branch block on ECG. The patient developed chest pain after a few hours and was diagnosed with AMI on ECG. The toxicology team started antivenom therapy. His troponin kept rising initially but later started coming down without percutaneous intervention (PCI). He was treated successfully with antivenom therapy and discharged.
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Lu ZY, Wang XD, Yan J, Ni XL, Hu SP. Critical lower extremity ischemia after snakebite: A case report. World J Clin Cases 2021; 9:7857-7862. [PMID: 34621838 PMCID: PMC8462238 DOI: 10.12998/wjcc.v9.i26.7857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/14/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Globally, the estimated annual incidence of snakebites is approximately 5 million, and approximately 100000 deaths occur from snakebites annually. Local tissue reaction, haemorrhagic clotting disorder, nephrotoxicity, and neurotoxicity are very common effects of snake envenomation, but other rarer complications, such as thrombosis, may also occur as a result of underlying disease. In the treatment of snakebite patients, attention should be paid to the patient’s underlying diseases to avoid serious and catastrophic consequences secondary to snakebite.
CASE SUMMARY We report a 69-year-old man with critical right lower extremity pain after left foot snakebite 10 d prior without intermittent claudication or atrial fibrillation history. He was diagnosed with acute right lower extremity arterial thrombosis, which may have been caused by coagulopathy after snakebite and lower extremity atherosclerotic occlusive disease. Lower extremity computed tomography angiography at another hospital revealed that the aortoiliac and femoral arteries had neither filling defects nor atherosclerosis, but the right popliteal artery was occluded 2.3 cm below the tibial plateau. The patient received emergency catheter-directed thrombolysis, but amputation was carried out 11 d after admission because the patient had been admitted to the hospital too late to save the extremity.
CONCLUSION Acute ischaemia of the lower extremity due to snakebite is a rare event, and physicians should bear in mind the serious complications that may occur, especially in patients with atherosclerotic disease.
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Affiliation(s)
- Zi-Ying Lu
- Department of Vascular Surgery, Tongde Hospital of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
| | - Xiao-Dong Wang
- Department of Vascular Surgery, Tongde Hospital of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
| | - Jin Yan
- Department of Vascular Surgery, Tongde Hospital of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
| | - Xiao-Long Ni
- Department of Vascular Surgery, Tongde Hospital of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
| | - Si-Pin Hu
- Department of Vascular Surgery, Tongde Hospital of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
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Simpson CH, Richardson WH, Swartzentruber GS, Lloyd VJ. ST Segment Elevation Myocardial Infarction Following a Crotalus horridus Envenomation. Wilderness Environ Med 2018; 29:383-387. [DOI: 10.1016/j.wem.2018.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/17/2018] [Accepted: 02/22/2018] [Indexed: 12/29/2022]
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Kounis NG, Cervellin G, Koniari I, Bonfanti L, Dousdampanis P, Charokopos N, Assimakopoulos SF, Kakkos SK, Ntouvas IG, Soufras GD, Tsolakis I. Anaphylactic cardiovascular collapse and Kounis syndrome: systemic vasodilation or coronary vasoconstriction? ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:332. [PMID: 30306071 DOI: 10.21037/atm.2018.09.05] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The first reported human anaphylactic death is considered to be the Pharaoh Menes death, caused by a wasp sting. Currently, anaphylactic cardiovascular events represent one of most frequent medical emergencies. Rapid diagnosis, prompt and appropriate treatment can be life saving. The main concept beyond anaphylaxis lies to myocardial damage and ventricular dysfunction, thus resulting in cardiovascular collapse. Cardiac output depression due to coronary hypoperfusion from systemic vasodilation, leakage of plasma and volume loss due to increased vascular permeability, as well as reduced venous return, are regarded as the main causes of cardiovascular collapse. Clinical reports and experiments indicate that the human heart, in general, and the coronary arteries, in particular, could be the primary target of the released anaphylactic mediators. Coronary vasoconstriction and thrombosis induced by the released mediators namely histamine, chymase, tryptase, cathepsin D, leukotrienes, thromboxane and platelet activating factor (PAF) can result to further myocardial damage and anaphylaxis associated acute coronary syndrome, the so-called Kounis syndrome. Kounis syndrome with increase of cardiac troponin and other cardiac biomarkers, can progress to heart failure and cardiovascular collapse. In experimental anaphylaxis, cardiac reactions caused by the intracardiac histamine and release of other anaphylactic mediators are followed by secondary cardiovascular reactions, such as cardiac arrhythmias, atrioventricular block, acute myocardial ischemia, decrease in coronary blood flow and cardiac output, cerebral blood flow, left ventricular developed pressure (LVdp/dtmax) as well as increase in portal venous and coronary vascular resistance denoting vascular spasm. Clinically, some patients with anaphylactic myocardial infarction respond satisfactorily to appropriate interventional and medical therapy, while anti-allergic treatment with antihistamines, corticosteroids and fluid replacement might be ineffective. Therefore, differentiating the decrease of cardiac output due to myocardial tissue hypoperfusion from systemic vasodilation and leakage of plasma, from myocardial tissue due to coronary vasoconstriction and thrombosis might be challenging during anaphylactic cardiac collapse. Combined antiallergic, anti-ischemic and antithrombotic treatment seems currently beneficial. Simultaneous measurements of peripheral arterial resistance and coronary blood flow with newer diagnostic techniques including cardiac magnetic resonance imaging (MRI) and myocardial scintigraphy may help elucidating the pathophysiology of anaphylactic cardiovascular collapse, thus rendering treatment more rapid and effective.
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Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology University of Patras Medical School, Rion, Patras, Achaia, Greece
| | | | - Ioanna Koniari
- Department of Electrophysiology, Queen Elizabeth Hospital, Birmingham, England
| | - Laura Bonfanti
- Emergency Department, Academic Hospital of Parma, Parma, Italy
| | | | - Nikolaos Charokopos
- Division of Pneumology, Department of Internal Medicine, General Hospital of Pirgos, Pirgos, Greece
| | - Stelios F Assimakopoulos
- Department of Internal Medicine, Division of Infectious Diseases, University of Patras Medical School, Patras, Greece
| | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Ioannis G Ntouvas
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - George D Soufras
- Department of Cardiology, "Saint Andrews State General Hospital", Patras, Achaia, Greece
| | - Ioannis Tsolakis
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
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Kounis NG, Koniari I, Roumeliotis A, Tsigkas G, Soufras G, Grapsas N, Davlouros P, Hahalis G. Thrombotic responses to coronary stents, bioresorbable scaffolds and the Kounis hypersensitivity-associated acute thrombotic syndrome. J Thorac Dis 2017; 9:1155-1164. [PMID: 28523173 DOI: 10.21037/jtd.2017.03.134] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Percutaneous transluminal coronary angioplasty with coronary stent implantation is a life-saving medical procedure that has become, nowadays, the most frequent performed therapeutic procedure in medicine. Plain balloon angioplasty, bare metal stents, first and second generation drug-eluting stents, bioresorbable and bioabsorbable scaffolds have offered diachronically a great advance against coronary artery disease and have enriched our medical armamentarium. Stented areas constitute vulnerable sites for endothelial damage, endothelial dysfunction, flow turbulence, hemorheologic changes, platelet dysfunction, coagulation changes and fibrinolytic disturbances. Implant surface attracts several proteins such as albumin, fibronectin, fibrinogen, and complement that lead to complement system activation. Macrophages recognize the implant as foreign substance due to protein adsorption and its continuous presence results in macrophage differentiation and fusion into foreign body giant cells. Polymer coating, stent metallic platforms and the released drugs can act as strong antigenic complex that apply continuous, repetitive, persistent and chronic hypersensitivity irritation to the coronary intima. The concomitant administration of oral antiplatelet drugs and environmental exposures can induce hypersensitivity inflammation. A class of platelets, activated via high-affinity and low-affinity IgE hypersensitivity receptors FCγRI, FCγRII, FCεRI and FCεRII, can induce Kounis hypersensitivity-associated thrombotic syndrome inside the stented coronaries. Type III variant of this syndrome is diagnosed when coronary artery stent thrombosis is associated with thrombus infiltrated by eosinophils or mast cells and/or when coronary intima, media and adventitia adjacent to stent, is infiltrated by eosinophils or mast cells. Careful history of hypersensitivity reactions to all implanted materials and concomitant drugs with monitoring of inflammatory mediators as well as lymphocyte transformation studies to detect hypersensitivity must be undertaken in order to avoid disastrous consequences. Food and Drug Administration recommendations for coronary stent implantation should be applied also to bioresorbable scaffolds. Further studies with inert and non-allergenic implants are necessary.
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Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Rion, Achaia, Greece
| | - Ioanna Koniari
- Department of Cardiology, University of Patras Medical School, Patras, Rion, Achaia, Greece
| | - Anastasios Roumeliotis
- Department of Cardiology, University of Patras Medical School, Patras, Rion, Achaia, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, University of Patras Medical School, Patras, Rion, Achaia, Greece
| | - George Soufras
- Department of Cardiology, University of Patras Medical School, Patras, Rion, Achaia, Greece
| | - Nicholas Grapsas
- Department of Cardiology, University of Patras Medical School, Patras, Rion, Achaia, Greece
| | - Periklis Davlouros
- Department of Cardiology, University of Patras Medical School, Patras, Rion, Achaia, Greece
| | - George Hahalis
- Department of Cardiology, University of Patras Medical School, Patras, Rion, Achaia, Greece
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Kounis NG, Mazarakis A, Bardousis C. Myocardial injury through serum troponin I and echocardiography in anaphylaxis: Takotsubo cardiomyopathy and the Kounis hypersensitivity-associated acute coronary syndrome. Am J Emerg Med 2016; 34:650-1. [PMID: 26792237 DOI: 10.1016/j.ajem.2015.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 12/12/2015] [Indexed: 12/16/2022] Open
Affiliation(s)
- Nicholas G Kounis
- Department of Medical Sciences, Southwestern Greece Highest Institute of Education and Technology, Patras, Achaia, Greece.
| | - Andreas Mazarakis
- Department of Cardiology, "Saint Andrews" State General Hospital, Patras, Achaia, Greece
| | - Constantinos Bardousis
- Department of Cardiology, "Saint Andrews" State General Hospital, Patras, Achaia, Greece; Department of Cardiology, University of Patras Medical Scholl, Rio, Patras, Achaia, Greece
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Gupta PN, Thomas J, Francis PK, Shylaja SV. +Ophitoxaemia and myocardial infarction--the issues during primary angioplasty: a review. BMJ Case Rep 2014; 2014:bcr-2013-201912. [PMID: 25342187 DOI: 10.1136/bcr-2013-201912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
'The Big four' are the most poisonous snakes in India, and especially in Kerala. These include the cobra, the viper, the krait and the sea snake. Most of the poisonous snakebites in India occur in Kerala. We believe there are only a few reports of myocardial infarction after snakebites and most of these are viper bites. We believe this is the second case of primary angioplasty for a snakebite. There are at least a few potential issues in performing a primary angioplasty in a snakebite case, namely (1) Is it a thrombus or a spasm? (2) Are the bleeding parameters deranged? Will the patient tolerate tirofiban and other glycoprotein (GB) 2b3a inhibitors? Will he develop dangerous bleeding due to the high dose of heparin needed? Further, would we save the patient from myocardial infarction only to lose him to renal failure, both due to the nephrotoxicity of the venom, the kidney being further damaged by the contrast media used for the angioplasty? We discuss all these issues as they crossed our mind, and hope it will help further treatment in others. We would like to review the available literature on these points and describe a recent case of ours.
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Affiliation(s)
- Prabha Nini Gupta
- Department of Cardiology, Medical College Hospital, Trivandrum, Kerala, India
| | - Jinesh Thomas
- Department of Cardiology, Medical College Hospital, Trivandrum, Kerala, India
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Kounis NG, Soufras GD, Hahalis G. Anaphylactic Shock: Kounis Hypersensitivity-Associated Syndrome Seems to be the Primary Cause. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 5:631-6. [PMID: 24404540 PMCID: PMC3877435 DOI: 10.4103/1947-2714.122304] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Experiments have shown that anaphylaxis decreases cardiac output; increases left ventricular end diastolic pressure; induces severe early acute increase in respiratory resistance with pulmonary interstitial edema; and decreases splanchnic, cerebral, and myocardial blood flow more than what would be expected from severe arterial dilation and hypotension. This is attributed to the constrictive action of inflammatory mediators released during anaphylactic shock. Inflammatory mediators such as histamine, neutral proteases, arachidonic acid products, platelet-activating factor (PAF), and a variety of cytokines and chemokines constitute the pathophysiologic basis of Kounis hypersensitivity-associated acute coronary syndrome. Although the mechanisms of anaphylactic shock still remain to be elucidated, myocardial involvement due to vasospasm-induced coronary blood flow reduction manifesting as Kounis syndrome should be always considered. Searching current experimental and clinical literature on anaphylactic shock pathophysiology, causality, clinical appearance, and treatment via PubMed showed that differentiating global hypoperfusion from primary tissue suppression due to mast cell mediator constrictive action on systemic arterial vasculature is a challenging procedure. Combined tissue suppression from arterial involvement and peripheral vasodilatation, perhaps, occur simultaneously. In cases of anaphylactic shock treatment targeting the primary cause of anaphylaxis together with protection of coronary vasculature and subsequently the cardiac tissue seems to be of paramount importance.
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Affiliation(s)
- Nicholas G Kounis
- Department of Medical Sciences, Patras Highest Institute of Education and Technology, Patras, Greece
| | - George D Soufras
- Department of Cardiology, 'Saint Andrews' State General Hospital, Patras, Greece
| | - George Hahalis
- Department of Cardiology, University of Patras Medical School, Rio, Patras, Greece
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Kounis NG, Soufras GD. Coronary stent thrombosis: beware of an allergic reaction and of Kounis syndrome. Indian Heart J 2013; 66:153-5. [PMID: 24814107 DOI: 10.1016/j.ihj.2013.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 12/04/2013] [Indexed: 12/11/2022] Open
Affiliation(s)
- Nicholas G Kounis
- Department of Medical Sciences, Patras Highest Institute of Education and Technology, Patras, Achaia, Greece.
| | - George D Soufras
- Department of Cardiology, "Saint Andrews" State General Hospital, Patras, Achaia, Greece
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