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Nanyoshi M, Hayashi T, Sugimoto R, Nishisaki H, Kenzaka T. Type I Kounis syndrome in a young woman without chest pain: a case report. BMC Cardiovasc Disord 2024; 24:467. [PMID: 39218904 PMCID: PMC11367997 DOI: 10.1186/s12872-024-04141-1] [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: 07/01/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Kounis syndrome is defined as the concurrence of acute coronary syndromes in the setting of allergic or anaphylactic reactions. It primarily affects men aged 40-70 years and is often associated with chest pain. This syndrome is often unrecognized and undiagnosed in clinical practice due to a low level of awareness. Herein, we present a case of type I Kounis syndrome in a young woman without chest pain. CASE PRESENTATION A 28-year-old Japanese woman with a history of atopic dermatitis received a glycyrrhizin, glutathione, and neurotropin preparation (a preparation of inflamed skin extract from rabbits inoculated with vaccinia virus) at a dermatology clinic to treat pruritus caused by atopic dermatitis. Immediately after the administration, the patient developed abdominal pain and generalized body wheals. The patient was diagnosed with anaphylaxis and was transported to our hospital. She had no chest pain on arrival at our hospital; however, a 12-lead electrocardiogram showed ST elevation in leads I, aVL, V2, and V3, and an echocardiogram showed decreased wall motion in the anterior and lateral walls of the left ventricle. Sublingual nitroglycerin administration improved ST-segment elevation and left ventricular wall motion abnormalities. The patient underwent emergency coronary angiography, which revealed no significant stenosis, and was diagnosed with type I Kounis syndrome. CONCLUSION Kounis syndrome without chest pain is rare in young women. Since it can be fatal in cases with severe allergic symptoms such as anaphylaxis, the possibility of concurrent acute coronary syndrome should be considered when treating systemic allergic reactions, regardless of age, sex, or the presence or absence of chest symptoms.
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Affiliation(s)
- Miki Nanyoshi
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7, Iso, Hikami-cho, Tamba, 669-3495, Japan
| | - Tomohiro Hayashi
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7, Iso, Hikami-cho, Tamba, 669-3495, Japan.
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Kobe, 652-0032, Japan.
| | - Ryu Sugimoto
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7, Iso, Hikami-cho, Tamba, 669-3495, Japan
| | - Hogara Nishisaki
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7, Iso, Hikami-cho, Tamba, 669-3495, Japan
| | - Tsuneaki Kenzaka
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7, Iso, Hikami-cho, Tamba, 669-3495, Japan
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Kobe, 652-0032, Japan
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2
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Puri P, Kachhadia MP, Sardana P, Bhagat R, Dekowski SS, Fohle E. Adrenaline, Takotsubo, Anaphylaxis, and Kounis Syndrome (ATAK) Complex Unveiled: Integrating Takotsubo and Kounis Syndromes in the Context of Chemotherapy-Related Anaphylaxis. Cureus 2024; 16:e53145. [PMID: 38420090 PMCID: PMC10900278 DOI: 10.7759/cureus.53145] [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: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
The convergence of takotsubo and Kounis syndromes, collectively referred to as the "ATAK complex" (short for adrenaline, takotsubo, anaphylaxis, and Kounis syndrome), poses a unique and challenging clinical scenario, especially in the context of chemotherapy-related anaphylaxis. We present a case report involving a 63-year-old woman undergoing chemotherapy for endometrial adenocarcinoma who experienced anaphylactic symptoms during treatment. Immediate administration of epinephrine was followed by the emergence of ST elevation, a reduced left ventricular ejection fraction, and wall motion abnormalities indicative of stress-induced cardiomyopathy. Detailed investigations revealed normal coronary arteries, prompting further exploration into the intricacies of the ATAK complex. Notably, the administration of intravenous rather than intramuscular epinephrine was identified as a contributing factor. This case underscores the critical importance of recognizing and managing the ATAK complex promptly, emphasizing the need for refined diagnostic and treatment guidelines. The interplay between adrenaline, takotsubo, anaphylaxis, and Kounis syndrome necessitates a nuanced approach, urging healthcare professionals to exercise caution and adhere to recommended administration routes. Increased awareness of the ATAK complex is imperative for optimizing patient outcomes and guiding therapeutic interventions in similar clinical scenarios. Further research is warranted to elucidate the underlying mechanisms and refine strategies for the effective management of this intricate syndrome.
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Affiliation(s)
- Piyush Puri
- Internal Medicine, Adesh Institute of Medical Science and Research, Bathinda, IND
| | - Meet Popatbhai Kachhadia
- Internal Medicine, Pandit Deendayal Upadhyay (PDU) Medical College, Civil Hospital Campus, Rajkot, IND
| | - Princy Sardana
- Internal Medicine, Saraswathi Institute of Medical Sciences, Hapur, IND
| | - Ridhi Bhagat
- Internal Medicine, Teerthanker Mahaveer Medical College and Reseach Center, Moradabad, IND
| | | | - Emmanuel Fohle
- Internal Medicine, University of North Dakota, Fargo, USA
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3
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Ballesteros RV, Polo JCG, Olmos C, Vilacosta I. Kounis and Takotsubo, Two Syndromes Bound by Adrenaline: The "ATAK" Complex. Case Rep Cardiol 2023; 2023:7706104. [PMID: 37744893 PMCID: PMC10513855 DOI: 10.1155/2023/7706104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023] Open
Abstract
Background. The term "ATAK" complex has been coined by the association of adrenaline, takotsubo, anaphylaxis and Kounis syndrome. We present an uncommon case of an "ATAK" complex with biphasic onset and a midventricular takotsubo pattern. Case Summary. A 50-year-old male was brought to the emergency department in anaphylactic shock. He had progressive exertional dyspnea and angina for the past 2 days. The intravenous administration of adrenaline for anaphylactic shock resulted in chest pain and concerning ECG repolarization findings. The patient was immediately transferred to the catheterization laboratory. Coronary angiography showed a midventricular ballooning pattern without significant coronary stenosis, with subsequent recovery during hospitalization, suggestive of takotsubo syndrome. The allergy tests remained inconclusive for the trigger. Discussion. Adrenaline-mediated stress is the link between these two entities, in which Kounis syndrome itself or anaphylactic shock treatment (adrenaline) are potential triggers for takotsubo syndrome.
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Affiliation(s)
| | - Juan Carlos Gómez Polo
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Carmen Olmos
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Isidre Vilacosta
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
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4
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ATAK Complex (Adrenaline, Takotsubo, Anaphylaxis, and Kounis Hypersensitivity-Associated Coronary Syndrome) after COVID-19 Vaccination and Review of the Literature. Vaccines (Basel) 2023; 11:vaccines11020322. [PMID: 36851200 PMCID: PMC9961741 DOI: 10.3390/vaccines11020322] [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: 12/08/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
Anaphylactic events triggered by mRNA COVID-19 vaccines are neither serious nor frequent. Kounis syndrome is described as the concomitant occurrence of acute coronary events and hypersensitivity reactions induced by vasospastic mediators after an allergic event. Kounis syndrome caused by vaccines is very rare. Up to now, only a few cases of allergic myocardial infarction after mRNA COVID-19 vaccine administration have been reported. Takotsubo cardiomyopathy is a syndrome characterized by transient wall movement abnormalities of the left ventricular apex, mid-ventricle, or other myocardial distribution, usually triggered by intense emotional or physical stress. Takotsubo cardiomyopathy after COVID-19 vaccine administration has been reported, usually with a delayed onset. A new entity characterized by the association of adrenaline administration, Takotsubo cardiomyopathy, anaphylaxis, and Kounis hypersensitivity was recently described: the ATAK complex. Here, we report a case of Takotsubo cardiomyopathy that occurred together with an anaphylactic reaction to an mRNA COVID-19 vaccine that required the use of adrenaline. The timing of the allergic reaction and the referenced clinical symptoms could not exclude the idea that Kounis syndrome occurred. Therefore, we can assume the patient presented the ATAK complex. We believe that highlighting on this ATAK complex will aid the application of proper diagnostic, preventive and therapeutic measures.
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Mirijello A, De Cosmo S. Adult anaphylaxis: To the heart of the matter. Eur J Intern Med 2022; 101:114. [PMID: 35379522 DOI: 10.1016/j.ejim.2022.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Antonio Mirijello
- Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy.
| | - Salvatore De Cosmo
- Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
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6
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Cho JH, Kim H, Yum J. Takotsubo syndrome and myasthenic crisis after radiocontrast media-induced anaphylaxis. JOURNAL OF NEUROCRITICAL CARE 2022. [DOI: 10.18700/jnc.210032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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7
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Kounis NG, Koniari I, Tsigkas G, Soufras GD, Plotas P, Davlouros P, Hahalis G. Angina following anaphylaxis: Kounis syndrome or adrenaline effect? MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2020; 15:97-98. [PMID: 33329871 PMCID: PMC7735888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- N G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Greece,
| | - I Koniari
- Electrophysiology and Device Department, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - G Tsigkas
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - G D Soufras
- Department of Cardiology, "Saint Andrews" State General Hospital, Patras, Greece
| | - P Plotas
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - P Davlouros
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - G Hahalis
- Department of Cardiology, University of Patras Medical School, Patras, Greece
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8
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Mirijello A, D'Errico MM, Piscitelli P, De Cosmo S. Electrocardiographic alterations and raised procalcitonin levels during anaphylactic shock. BMJ Case Rep 2020; 13:13/1/e233521. [PMID: 31969417 DOI: 10.1136/bcr-2019-233521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Anaphylaxis represents a systemic disease occurring after the exposure to an allergen. Drugs for the treatment of anaphylactic reactions (ie, corticosteroids and adrenalin) could induce autonomic alterations, such as tachycardia, hyperthermia, tachypnoea and leucocytosis. We describe the case of a 52-year-old woman presenting with a severe allergic reaction after the ingestion of amoxicillin-clavulanate. The occurrence of ECG alterations, laboratory abnormalities and procalcitonin (PCT) elevation will be discussed with particular emphasis on the possible misleading role of PCT during anaphylactic shock.
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Affiliation(s)
- Antonio Mirijello
- Department of Medical Sciences, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Maria Maddalena D'Errico
- Department of Medical Sciences, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Pamela Piscitelli
- Department of Medical Sciences, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Salvatore De Cosmo
- Department of Medical Sciences, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
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9
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Jiang C, Li H. Electrocardiographic Changes After Overdose of Epinephrine in a Patient With Anaphylaxis: Kounis Syndrome or Epinephrine? JAMA Intern Med 2019; 179:973-974. [PMID: 31081848 DOI: 10.1001/jamainternmed.2019.1230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Chunyan Jiang
- Department of Internal Medicine, Health Care Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongwei Li
- Department of Internal Medicine, Health Care Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Metabolic Disorder-Related Cardiovascular Disease, Beijing, China
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10
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11
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Margonato D, Abete R, Di Giovine G, Delfino P, Grillo M, Mazzetti S, Poggio D, Rossi J, Khouri T, Mortara A. Takotsubo cardiomyopathy associated with Kounis syndrome: A clinical case of the "ATAK complex". J Cardiol Cases 2019; 20:52-56. [PMID: 31440312 DOI: 10.1016/j.jccase.2019.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/19/2019] [Accepted: 03/25/2019] [Indexed: 11/28/2022] Open
Abstract
A 60-year-old female developed cardiac arrest after experiencing an anaphylactic shock during administration of plasma-expanders. An electrocardiogram registered after restoration of sinus rhythm showed mild ST-elevation in the anterior precordial leads and T waves changes followed by appearance of echocardiographic alterations of left ventricular apex kinesis. Coronary angiography revealed normal coronary arteries, and cardiovascular magnetic resonance confirmed apical ballooning with late gadolinium enhancement in the segments with abnormal contractility. This uncommon clinical case confirms how takotsubo and Kounis syndrome may converge in a single nosological entity, the so-called "ATAK complex" (Adrenaline, Tako-Tsubo, Anaphylaxis, and Kounis), with a specific management and prognostic implications. <Learning objective: The Kounis syndrome has a clinical presentation that poses a difficult differential diagnosis with takotsubo cardiomyopathy. Despite recent significant improvements in the understanding of these two clinical conditions, the pathogenesis of these two entities and, in particular, how they may converge into the clinical scenario of the "ATAK complex" remain to be clarified. We believe that this rare clinical case may help physicians in the correct identification and management of this frequently misdiagnosed clinical disease.>.
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Affiliation(s)
- Davide Margonato
- Department of Cardiology, Policlinico di Monza, Monza, Italy.,Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Raffaele Abete
- Department of Cardiology, Policlinico di Monza, Monza, Italy.,Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Pietro Delfino
- Department of Cardiology, Policlinico di Monza, Monza, Italy
| | | | - Simone Mazzetti
- Department of Cardiology, Policlinico di Monza, Monza, Italy
| | - Daniele Poggio
- Department of Cardiology, Policlinico di Monza, Monza, Italy
| | - Jessica Rossi
- Department of Cardiology, Policlinico di Monza, Monza, Italy.,Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Toufic Khouri
- Department of Radiology, Policlinico di Monza, Monza, Italy
| | - Andrea Mortara
- Department of Cardiology, Policlinico di Monza, Monza, Italy
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12
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De Gennaro L, Brunetti ND, Locuratolo N, Ruggiero M, Resta M, Diaferia G, Rana M, Caldarola P. Kounis syndrome following canned tuna fish ingestion. Acta Clin Belg 2017; 72:142-145. [PMID: 27997286 DOI: 10.1080/17843286.2016.1265756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Kounis syndrome (KS) is a complex of cardiovascular symptoms and signs following either allergy or hypersensitivity and anaphylactic or anaphylactoid insults. We report the case of 57-year-old man, with hypertension and history of allergy, referred for facial rash and palpitations appeared after consumption of canned tuna fish. Suddenly, the patient collapsed: electrocardiogram showed ST-elevation in inferior leads. The patient was transferred from the spoke emergency room for coronary angio, which did not show any sign of coronary atherosclerosis. A transient coronary spasm was therefore hypothesized and the final diagnosis was KS. To the best of our knowledge, this is one of the first cases of KS following the ingestion of tuna fish. KS secondary to food allergy has also been reported, and shellfish ingestion has been considered as one of the most active KS inducer foods. Canned tuna fish too is well known as an allergy inducer. Tuna fish allergy should be considered, however, within the context of scombroid food poisoning, also called histamine fish poisoning. Fish with high levels of free histidine, the enzyme substrate converted to histamine by bacterial histidine decarboxylase, are those most often implicated in scombroid poisoning. Inflammatory mediators such as histamine constitute the pathophysiologic basis of Kounis hypersensitivity-associated acute coronary syndrome. Patients with coronary risk factors, allergic reaction after food ingestion, and suspected scombroid poisoning should be therefore carefully monitored for a prompt diagnosis of possible coronary complications.
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Affiliation(s)
| | | | | | | | - Manuela Resta
- Cardiology Department, Ospedale S. Paolo, Bari, Italy
| | - Giuseppe Diaferia
- Cardiology Department, Ospedale Caduti di Tutte le Guerre, Canosa, Italy
| | - Michele Rana
- Cardiology Department, Ospedale Caduti di Tutte le Guerre, Canosa, Italy
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13
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Gouel-Chéron A, Harpan A, Mertes PM, Longrois D. Management of anaphylactic shock in the operating room. Presse Med 2016; 45:774-83. [DOI: 10.1016/j.lpm.2016.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/06/2016] [Indexed: 12/14/2022] Open
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14
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Kounis NG, Soufras GD. Shoulder arthroscopy and ATAK (adrenaline, Takotsubo, anaphylaxis, and Kounis hypersensitivty-associated syndrome). Orthop Traumatol Surg Res 2016; 102:273-4. [PMID: 26896412 DOI: 10.1016/j.otsr.2016.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 01/15/2016] [Indexed: 02/02/2023]
Affiliation(s)
- N G Kounis
- Department of Medical Sciences, Western Greece Highest Institute of Education and Technology, 7, Aratou Street, Queen Olgas, square, 26221 Patras, Greece.
| | - G D Soufras
- Department of Medical Sciences, Western Greece Highest Institute of Education and Technology, 7, Aratou Street, Queen Olgas, square, 26221 Patras, Greece
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15
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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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16
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Madias JE. Epinephrine administration and Takotsubo syndrome: Lessons from past experiences. Int J Cardiol 2016; 207:100-2. [DOI: 10.1016/j.ijcard.2016.01.145] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 01/06/2016] [Indexed: 11/15/2022]
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Kounis NG, Soufras GD, Davlouros P, Tsigkas G, Hahalis G. Combined etiology of anaphylactic cardiogenic shock: amiodarone, epinephrine, cardioverter defibrillator, left ventricular assist devices and the Kounis syndrome. Ann Card Anaesth 2016; 18:261-4. [PMID: 25849705 PMCID: PMC4881635 DOI: 10.4103/0971-9784.154498] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Anaphylactic shock is a life-threatening condition which needs detailed and mediculous clinical assessment and thoughtful treatment. Several causes can join forces in order to degranulate mast cells. Amiodarone which is an iodine-containing highly lipophilic benzofuran can induce allergic reactions and anaphylactic shock in sensitized patients. Epinephrine is a life saving drug, but in sulfite allergic patients it should be given with caution due its metabisulfite preservative. Metals covering cardiac defibrillators and pacemakers can act as antigens attached to serum proteins and induce allergic reactions. In anaphylactic shock, myocardial involvement due to vasospasm-induced coronary blood flow reduction manifesting as Kounis syndrome should be always considered. Clinically, combined treatment targeting the primary cause of anaphylaxis together with protection of cardiac tissue seems to be of paramount importance.
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Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Rio, Achaia, Greece
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18
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Attack the ATAK : “οὓς ὁ θεὸς συνέζευξε, ἄνθρωπος μὴ χωριζέτω” (ous o theos synezeuxe anthropos me horizeto) “what therefore God hath joined together, let not man put asunder”. Int J Cardiol 2016; 203:960-1. [DOI: 10.1016/j.ijcard.2015.11.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 11/16/2015] [Indexed: 11/17/2022]
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Hirose K, Moriya M, Ishiwata S, Ohno M. A case of Takotsubo cardiomyopathy that was confirmed by cardiac catheterization at all three times of onset. J Cardiol Cases 2015; 12:152-155. [DOI: 10.1016/j.jccase.2015.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/02/2015] [Accepted: 06/22/2015] [Indexed: 11/15/2022] Open
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Kounis NG, Giannopoulos S, Soufras GD, Kounis GN, Goudevenos J. Foods, Drugs and Environmental Factors: Novel Kounis Syndrome Offenders. Intern Med 2015; 54:1577-82. [PMID: 26134186 DOI: 10.2169/internalmedicine.54.3684] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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 is hypersensitivity coronary disorder induced by various types of environmental exposures, drugs, conditions and stents. Allergic, hypersensitivity, anaphylactic and anaphylactoid reactions are associated with this syndrome. The disorder manifests as coronary spasms, acute myocardial infarction and stent thrombosis and affects the cerebral and mesenteric as well as coronary arteries. Importantly, its manifestations are broad and its etiology is continuously increasing. Recently, a variety of unusual etiologies have been reported including Anisakis simplex, scombroid syndrome, the use of Gelofusin or ultrasound contrast agents, kiwifruit, fly bites, and bee stings. Furthermore, losartan and the paradox of corticosteroid allergy have been implicated as possible causes. Although not rare, Kounis syndrome is infrequently diagnosed. Therefore, awareness of its etiology, manifestations and pathophysiology is important for providing the proper diagnosis and treatment and determining prognosis.
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Affiliation(s)
- Nicholas G Kounis
- Department of Medical Sciences, Patras Highest Institute of Education and Technology, Greece
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Mazarakis A, Bardousis K, Almpanis G, Mazaraki I, Markou S, Kounis NG. Kounis syndrome following cold urticaria: the swimmer's death. Int J Cardiol 2014; 176:e52-3. [PMID: 25064198 DOI: 10.1016/j.ijcard.2014.07.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/05/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Andreas Mazarakis
- Department of Cardiology, "Saint Andrews" State General Hospital, Patras, Achaia, Greece
| | - Konstantinos Bardousis
- Department of Cardiology, "Saint Andrews" State General Hospital, Patras, Achaia, Greece
| | - George Almpanis
- Department of Cardiology, "Saint Andrews" State General Hospital, Patras, Achaia, Greece
| | - Ira Mazaraki
- Department of Cardiology, "Saint Andrews" State General Hospital, Patras, Achaia, Greece
| | - Spiros Markou
- Department of Cardiology, "Saint Andrews" State General Hospital, Patras, Achaia, Greece
| | - Nicholas G Kounis
- Department of Medical Sciences, Northwestern Greece Highest Institute of Education and Technology, Patras, Achaia, Greece.
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22
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Singh K, Carson K, Usmani Z, Sawhney G, Shah R, Horowitz J. Systematic review and meta-analysis of incidence and correlates of recurrence of takotsubo cardiomyopathy. Int J Cardiol 2014; 174:696-701. [DOI: 10.1016/j.ijcard.2014.04.221] [Citation(s) in RCA: 163] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/17/2014] [Accepted: 04/19/2014] [Indexed: 12/17/2022]
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