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Lin XN, Zeng YJ, Cao S, Jing XB. A real-world pharmacovigilance study of cardiac adverse events induced by sugammadex in the FDA adverse event reporting system. Expert Opin Drug Saf 2024:1-9. [PMID: 39174878 DOI: 10.1080/14740338.2024.2396645] [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: 06/24/2024] [Revised: 07/31/2024] [Accepted: 08/10/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Sugammadex is a novel agent that reverses neuromuscular blockade during general anesthesia. Recent case reports have raised concerns regarding potential cardiac adverse events (CAEs). However, no large-scale real-world studies have yet evaluated the potential link between sugammadex and CAEs. RESEARCH DESIGN AND METHODS Data from the FDA Adverse Event Reporting System were obtained. The association between sugammadex and CAE was evaluated using reporting odds ratio, proportional reporting ratio, Bayesian confidence propagation neural network, and multi-item gamma Poisson shrinker methods. Serious outcomes resulting from sugammadex-related CAEs were assessed, and complications associated with CAEs were evaluated. RESULTS Nineteen CAEs were identified and classified into two categories: cardiac arrhythmias and coronary artery disorders. The most frequent CAEs were bradycardia (n = 202), cardiac arrest (n = 119), tachycardia (n = 30), and Kounis syndrome (n = 22). Subgroup analysis based on age, sex, and weight revealed parallel findings. The CAEs most likely to result in serious consequences were pulseless electrical activity and cardiac arrest. The most common concurrent adverse effects with CAEs were hypotension (n = 51), anaphylactic reactions (n = 46), and anaphylactic shock (n = 23). CONCLUSION This study suggests a potential link between sugammadex and CAEs, highlighting the need for careful monitoring and personalized risk assessment, especially in patients with cardiovascular risk factors.
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Affiliation(s)
- Xiao-Na Lin
- Department of Cardiovascular Surgery, Shandong Second Provincial General Hospital, Jinan, China
| | - You-Jie Zeng
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Si Cao
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-XIANGYA, Changsha, Hunan, China
| | - Xi-Bo Jing
- Department of Structural Cardiology, Shandong Second Provincial General Hospital, Jinan, China
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2
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Ebrahimi P, Nazari R, Senobari N, Mousavinezhad SM, Ghadimi DJ, Soleimani H. Kounis syndrome type I induced by an intramuscular injection of diclofenac: A literature review based on a case report. Clin Case Rep 2024; 12:e9198. [PMID: 39040609 PMCID: PMC11260766 DOI: 10.1002/ccr3.9198] [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: 03/27/2024] [Revised: 06/10/2024] [Accepted: 07/08/2024] [Indexed: 07/24/2024] Open
Abstract
Key Clinical Message The history of any allergy to the medications should be asked by physicians before administration of the medication. The coincidence of allergic and ACS symptoms after a short time of drug administration might be an indicator of Kounis syndrome. Allergic and coronary symptoms should be considered and treated. Abstract Ischemic heart disease is still the leading cause of death worldwide. Some medications, including NSAIDS and antibiotics, can cause allergic reactions with cardiac manifestations due to spasms of the coronary arteries. In this case, we present a patient with chest pain syndrome due to a hypersensitivity reaction caused by an intramuscular (IM) diclofenac injection. The patient was a 51-year-old male who presented to the emergency department complaining of retrosternal chest pain, breathlessness, and pruritis that started half an hour after an IM diclofenac injection he had because of low back pain. The allergic symptoms subsided with an antihistamine injection, but chest pain and dyspnea remained stable. He was admitted due to the presence of ST-segment depression in leads II, III, and AVF and underwent percutaneous coronary angiography, which was normal. The patient was discharged with the diagnosis of Kounis syndrome, and he had an uneventful follow-up 1 year later. Kounis hypersensitivity-associated acute coronary syndrome, especially type I variant coronary spasm due to endothelial dysfunction is a type of acute myocardial syndrome. The following report describes an uncommon case of anaphylaxis-associated Kounis type I syndrome manifesting ST-segment changes in a male patient following an intramuscular injection of diclofenac.
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Affiliation(s)
- Pouya Ebrahimi
- Cardiology Department, Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Roozbeh Nazari
- Department of Cardiology, Modarres HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Nahid Senobari
- Department of Cardiology, Modarres HospitalShahid Beheshti University of Medical SciencesTehranIran
| | | | - Delaram J. Ghadimi
- Radiology Department, School of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Hamidreza Soleimani
- Cardiology Department, Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
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Cesarz T, Ganti L. Kounis syndrome: ST elevations in the setting of anaphylaxis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100152. [PMID: 37781662 PMCID: PMC10509885 DOI: 10.1016/j.jacig.2023.100152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/27/2023] [Accepted: 05/08/2023] [Indexed: 10/03/2023]
Abstract
Acute coronary syndrome in the presence of an allergic reaction is known as Kounis syndrome, which is an underdiagnosed disorder and has nuances regarding management. We present a patient brought to the hospital as an ST segment elevation myocardial infarction (STEMI) alert in the setting of an allergic reaction triggered by food.
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Affiliation(s)
- Taylor Cesarz
- University of Central Florida College of Medicine, Orlando, Fla
| | - Latha Ganti
- University of Central Florida College of Medicine, Orlando, Fla
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4
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Pejcic AV, Milosavljevic MN, Jankovic S, Davidovic G, Folic MM, Folic ND. Kounis Syndrome Associated With the Use of Diclofenac. Tex Heart Inst J 2023; 50:490621. [PMID: 36735919 PMCID: PMC9969777 DOI: 10.14503/thij-21-7802] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Diclofenac is a widely used analgesic, anti-inflammatory, antipyretic drug. In several case reports, its use was associated with the occurrence of Kounis syndrome. The aim of this review was to investigate and summarize published cases of Kounis syndrome suspected to be associated with the use of diclofenac. METHODS Electronic searches were conducted in PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and the Serbian Citation Index. RESULTS Twenty publications describing the 20 patients who met inclusion criteria were included in the systematic review. Specified patient ages ranged from 34 to 81 years. Eighteen (90.0%) patients were male. Five patients (25.0%) reported a previous reaction to diclofenac. Reported time from the used dose of diclofenac to onset of the first reaction symptoms ranged from immediately to 5 hours. Diclofenac caused both type I and type II Kounis syndrome, with the presence of various cardiovascular, gastrointestinal, dermatologic, and respiratory signs and symptoms. Most patients experienced hypotension (n = 15 [75.0%]) and chest pain (n = 12 [60.0%]). The most frequently reported finding on electrocardiogram was ST-segment elevations (n = 17 [85.0%]). Coronary angiogram showed normal coronary vessels in 9 patients (45.0%), with some pathologic findings in 8 patients (40.0%). CONCLUSION Clinicians should be aware that Kounis syndrome may be an adverse effect of diclofenac. Prompt recognition and withdrawal of the drug, with treatment of both allergic and cardiac symptoms simultaneously, is important.
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Affiliation(s)
- Ana V. Pejcic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Milos N. Milosavljevic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Slobodan Jankovic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
,Clinical Pharmacology Department, University Clinical Centre Kragujevac, Kragujevac, Serbia
| | - Goran Davidovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Marko M. Folic
- Clinical Pharmacology Department, University Clinical Centre Kragujevac, Kragujevac, Serbia
,Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Nevena D. Folic
- Pediatric Clinic, University Clinical Centre Kragujevac, Kragujevac, Serbia
,Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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5
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Abstract
A 67-year-old woman experienced pruritus, an urticarial rash, and acute, pressure-like chest pain following an insect sting. Initial electrocardiographic findings were notable for ST-segment elevations in the inferior leads without reciprocal changes, but a follow-up electrocardiogram showed pronounced ST-segment elevations in the inferior leads with reciprocal changes. Her troponin I level peaked at 3,053 pg/mL, and she was transferred to a large academic center for percutaneous coronary intervention. Balloon angioplasty was performed for 95% thrombotic occlusion of the mid-right coronary artery, and a drug-eluting stent was placed. The patient's presentation was consistent with type II Kounis syndrome.
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Affiliation(s)
- Rahul V. Annabathula
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Mahesh A. Chandrasekhar
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Luke A. Peters
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Roach K, Roberts J. A comprehensive summary of disease variants implicated in metal allergy. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2022; 25:279-341. [PMID: 35975293 PMCID: PMC9968405 DOI: 10.1080/10937404.2022.2104981] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Allergic disease represents one of the most prominent global public health crises of the 21st century. Although many different substances are known to produce hypersensitivity responses, metals constitute one of the major classes of allergens responsible for a disproportionately large segment of the total burden of disease associated with allergy. Some of the most prevalent forms of metal allergy - including allergic contact dermatitis - are well-recognized; however, to our knowledge, a comprehensive review of the many unique disease variants implicated in human cases of metal allergy is not available within the current scientific literature. Consequently, the main goal in composing this review was to (1) generate an up-to-date reference document containing this information to assist in the efforts of lab researchers, clinicians, regulatory toxicologists, industrial hygienists, and other scientists concerned with metal allergy and (2) identify knowledge gaps related to disease. Accordingly, an extensive review of the scientific literature was performed - from which, hundreds of publications describing cases of metal-specific allergic responses in human patients were identified, collected, and analyzed. The information obtained from these articles was then used to compile an exhaustive list of distinctive dermal/ocular, respiratory, gastrointestinal, and systemic hypersensitivity responses associated with metal allergy. Each of these disease variants is discussed briefly within this review, wherein specific metals implicated in each response type are identified, underlying immunological mechanisms are summarized, and major clinical presentations of each reaction are described.Abbreviations: ACD: allergic contact dermatitis, AHR: airway hyperreactivity, ASIA: autoimmune/ autoinflammatory syndrome induced by adjuvants, BAL: bronchoalveolar lavage, CBD: chronic beryllium disease, CTCL: cutaneous T-cell lymphoma, CTL: cytotoxic T-Lymphocyte, DRESS: drug reaction with eosinophilia and systemic symptoms, GERD: gastro-esophageal reflux disease, GI: gastrointestinal, GIP: giant cell interstitial pneumonia, GM-CSF: granulocyte macrophage-colony stimulating factor, HMLD: hard metal lung disease, HMW: high molecular weight, IBS: irritable bowel syndrome, Ig: immunoglobulin, IL: interleukin, LMW: low molecular weight, PAP: pulmonary alveolar proteinosis, PPE: personal protective equipment, PRR: pathogen recognition receptor, SLE: systemic lupus erythematosus, SNAS: systemic nickel allergy syndrome, Th: helper T-cell, UC: ulcerative colitis, UV: ultraviolet.
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Affiliation(s)
- Ka Roach
- Allergy and Clinical Immunology Branch (ACIB), National Institute of Occupational Safety and Health (NIOSH), Morgantown, WV, USA
| | - Jr Roberts
- Allergy and Clinical Immunology Branch (ACIB), National Institute of Occupational Safety and Health (NIOSH), Morgantown, WV, USA
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7
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Wang C, Fang W, Song L, Deng Z, Li Z, Sun L. Analysis of Clinical Features of Non-steroidal Anti-inflammatory Drugs Induced Kounis Syndrome. Front Cardiovasc Med 2022; 9:901522. [PMID: 35898282 PMCID: PMC9309368 DOI: 10.3389/fcvm.2022.901522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Current knowledge of Kounis syndrome induced by non-steroidal anti-inflammatory drugs (NSAIDs) is based on case reports. This study aimed to investigate the clinical features of Kounis syndrome. Methods Case reports of the NSAIDs-induced Kounis syndrome were analyzed by searching Chinese and English databases from 1 January 1950 to 31 January 2022. Results The median age of the 45 included patients (28 women) was 51 years (20–80 years). NSAIDs that were the most frequently involved were diclofenac (26.7%, 12/45), metamizole (15.6%, 7/45), and aspirin (13.3%, 6/45). Kounis syndrome occurred mainly within 30 min after administration, with a maximum latency of 1 month. Chest pain (75.6%, 34/45), dyspnea (33.3%, 15/45), and allergic reactions (44.4%, 20/45) were the most common clinical manifestations. Thirty patients (66.7%) had an ST-segment elevation on the electrocardiogram. Echocardiogram and coronary angiography showed abnormalities in 21 patients (75%, 21/28) and 15 patients (37.5%, 15/40). Forty-four patients (97.8%) had a good prognosis after treatment with steroids, antihistamines, and vasodilators. Conclusion The possibility of Kounis syndrome should be considered in the presence of coronary artery disease symptoms when taking NSAIDs. Kounis syndrome can be life-threatening. It is essential to identify and treat Kounis syndrome correctly.
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Affiliation(s)
- Chunjiang Wang
- 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
| | - Liying Song
- 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
| | - Zuojun Li
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Linli Sun
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Linli Sun
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8
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Epidemiology, clinical ramifications, and cellular pathogenesis of COVID-19 mRNA-vaccination-induced adverse cardiovascular outcomes: A state-of-the-heart review. Biomed Pharmacother 2022; 149:112843. [PMID: 35325848 PMCID: PMC8934717 DOI: 10.1016/j.biopha.2022.112843] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/10/2022] [Accepted: 03/17/2022] [Indexed: 11/23/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) has overwhelming healthcare systems globally. To date, a myriad of therapeutic regimens has been employed in an attempt to curb the ramifications of a severe COVID-19 infection. Amidst the ongoing pandemic, the advent and efficacious uptake of COVID-19 vaccination has significantly reduced disease-related hospitalizations and mortality. Nevertheless, many side-effects are being reported after COVID-19 vaccinations and myocarditis is the most commonly reported sequelae post vaccination. Majority of these diseases are associated with COVID-19 mRNA vaccines. Various studies have established a temporal relationship between these complications, yet the causality and the underlying pathogenesis remain hypothetical. In this review, we aim to critically appraise the available literature regarding the cardiovascular side effects of the various mRNA vaccines and the associated pathophysiology.
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Dai B, Cavaye J, Judd M, Beuth J, Iswariah H, Gurunathan U. Perioperative presentations of Kounis syndrome: a systematic literature review. J Cardiothorac Vasc Anesth 2022; 36:2070-2076. [DOI: 10.1053/j.jvca.2022.01.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/11/2022]
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10
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Sirur FM, Wilson W, Gopinathan V, Chethana AS, Lekha N. Hymenoptera heartaches -cardiac manifestation with hymenoptera stings, a retrospective study from a tertiary care hospital in South India. Am J Emerg Med 2021; 50:294-300. [PMID: 34425322 DOI: 10.1016/j.ajem.2021.08.003] [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: 06/14/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Hymenoptera stings usually have a multitude of presentations from very subtle to life-threatening conditions. Various cardiac manifestations including Kounis syndrome often get missed due to lack of suspicion. The aim of the study was to describe the clinical profile of the cardiac etiologies associated with hymenoptera stings and review literature with focus on diagnosis and treatment strategies. METHODOLOGY A retrospective chart analysis was performed including all adult patients who had a hymenoptera sting during a two-year window (October 2018 - October 2020). Of these, patients with cardiac features were enrolled. A structured case record form was used to capture information like basic demography, clinical profile, and outcomes. RESULTS Thirteen cases presented with hymenoptera stings of which six cases had cardiac presentation and were considered. The most common presentations were breathlessness and generalised itching with only one patient complaining of chest pain. All patients(with available data) had ECG changes suggestive of ischemia and associated raised troponin levels with 2D echo changes. The diagnoses considered included Kounis syndrome, hypersensitivity myocarditis, and Takotsubo cardiomyopathy. Patients were managed conservatively with one patient undergoing a coronary angiography. All patients were stable at discharge. CONCLUSION Cardiac manifestations with hymenoptera stings although rare may complicate diagnosis and treatment.It should be borne in mind during assessment and standardised guidelines should be developed for ED treatment such as the one recommended in this study.
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Affiliation(s)
- Freston Marc Sirur
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - William Wilson
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Vivek Gopinathan
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - A S Chethana
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Nymisha Lekha
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Çakmak A, Keskin G. Kounis syndrome: Is ceftriaxone or metronidazole responsible for acute myocardial infarction? A rare case. Anatol J Cardiol 2021; 25:451-452. [PMID: 34100733 DOI: 10.5152/anatoljcardiol.2020.36422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Abdulkadir Çakmak
- Department of Cardiology, Faculty of Medicine, Amasya University; Amasya-Turkey
| | - Gökhan Keskin
- Department of Cardiology, Faculty of Medicine, Amasya University; Amasya-Turkey
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12
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Özdemir İH, Özlek B, Özen MB, Gündüz R, Bayturan Ö. Type 1 Kounis Syndrome Induced by Inactivated SARS-COV-2 Vaccine. J Emerg Med 2021; 61:e71-e76. [PMID: 34148772 PMCID: PMC8103145 DOI: 10.1016/j.jemermed.2021.04.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/10/2021] [Accepted: 04/26/2021] [Indexed: 12/14/2022]
Abstract
Background Vaccination is the most important way out of the novel coronavirus disease 2019 (COVID-19) pandemic. Vaccination practices have started in different countries for community immunity. In this process, health authorities in different countries have preferred different type of COVID-19 vaccines. Inactivated COVID-19 vaccine is one of these options and has been administered to more than 7 million people in Turkey. Inactivated vaccines are generally considered safe. Kounis syndrome (KS) is a rare clinical condition defined as the co-existence of acute coronary syndromes and allergic reactions. Case Report We present the case of a 41-year-old woman with no cardiovascular risk factors who was admitted at our emergency department with flushing, palpitation, dyspnea, and chest pain 15 min after the first dose of inactivated CoronaVac (Sinovac Life Sciences, Beijing, China). Electrocardiogram (ECG) showed V4-6 T wave inversion, and echocardiography revealed left ventricular wall motion abnormalities. Troponin-I level on arrival was elevated. Coronary angiography showed no sign of coronary atherosclerosis. She was diagnosed with type 1 KS. The patient's symptoms resolved and she was discharged from hospital in a good condition. Why Should an Emergency Physician Be Aware of This? To the best of our knowledge, this is the first case of allergic myocardial infarction secondary to inactivated coronavirus vaccine. This case demonstrates that KS can occur after inactivated virus vaccine against COVID-19. Although the risk of severe allergic reaction after administration of CoronaVac seems to be very low, people who developed chest pain after vaccine administration should be followed by ECG and troponin measurements.
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Affiliation(s)
| | - Bülent Özlek
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | | | - Ramazan Gündüz
- Department of Cardiology, Manisa City Hospital, Manisa, Turkey
| | - Özgür Bayturan
- Department of Cardiology, Manisa Celal Bayar University, Faculty of Medicine, Manisa, Turkey
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13
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Özlek B, Özlek E, Gökçek A. Reply to the letter: "Kounis syndrome: Towards a new classification". Int J Cardiol 2021; 335:25. [PMID: 33930511 DOI: 10.1016/j.ijcard.2021.04.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/22/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Bülent Özlek
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey.
| | - Eda Özlek
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Aysel Gökçek
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
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14
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Dimos A, Xanthopoulos A, Bismpos D, Triposkiadis F, Skoularigis J. Delayed Acute Coronary Syndrome Caused by Multiple Bee Stings: A Rare Case of Kounis Syndrome. Cureus 2021; 13:e14120. [PMID: 33927928 PMCID: PMC8075771 DOI: 10.7759/cureus.14120] [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] [Indexed: 11/05/2022] Open
Abstract
A 51-year-old female patient was admitted to our hospital for medical evaluation and treatment of a syncopal episode following multiple bee stings. The syncopal episode was attributed to an allergic reaction and the patient was treated with intravenous hydration and anti-histamines. Twenty-four hours later, the patient manifested an acute coronary syndrome with chest discomfort, electrocardiographic disorders, and myocardial enzyme motility (including troponin). Coronary angiography was performed without revealing pathological findings and she was diagnosed with Kounis syndrome type I. The management of the patient included administration of single antiplatelet therapy combined with a calcium channel blocker (CCB). The patient follow-up was uncomplicated. In patients with Kounis syndrome type I undergoing a normal coronary angiography, in the absence of specific guidelines, single antiplatelet therapy and CCB may be a reasonable approach.
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Affiliation(s)
- Apostolos Dimos
- Department of Cardiology, University Hospital of Larissa, Larissa, GRC
| | | | - Dimitrios Bismpos
- Department of Cardiology, Interbalkan Medical Center, Thessaloniki, GRC
| | | | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, Larissa, GRC
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Liang HZ, Zhao H, Gao J, Cao CF, Wang WM. Epirubicin-induced Kounis syndrome. BMC Cardiovasc Disord 2021; 21:133. [PMID: 33711934 PMCID: PMC7953621 DOI: 10.1186/s12872-021-01936-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/25/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Kounis syndrome is an acute coronary syndrome that appears in the setting of anaphylactic reaction or hypersensitivity. Many drugs and environmental exposures have been identified as potential offenders, and diagnosis and treatment can be challenging. CASE PRESENTATION A 62-year-old man with recurrent bladder cancer underwent an intra-iliac artery epirubicin injection. After the injection, he developed chest pain and a systemic allergic reaction, with electrocardiographic alterations and elevated troponin-I levels. Emergent coronary angiography showed right coronary artery spasm and no stenosis of the other coronary arteries. This reaction was considered compatible with an allergic coronary vasospasm. A diagnosis of Kounis syndrome was made. CONCLUSIONS Kounis syndrome is common, but a prompt diagnosis is often not possible. This case is the first to suggest that an intraarterial epirubicin injection could potentially be one of its triggers. All physicians should be aware of the pathophysiology of this condition to better recognize it and start appropriate treatment; this will prevent aggravation of the vasospastic cardiac attacks and yield a better outcome.
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Affiliation(s)
- Hui-zhu Liang
- Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Hong Zhao
- Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Jian Gao
- Department of Radiology, Peking University People’s Hospital, Beijing, China
| | - Cheng-fu Cao
- Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Wei-min Wang
- Department of Cardiology, Peking University People’s Hospital, Beijing, China
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16
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Wu H, Cao Y, Chang F, Zhang C, Hu Y, Liang L. Kounis Syndrome Induced by Anisodamine: A Case Report. Int J Gen Med 2020; 13:1523-1527. [PMID: 33363401 PMCID: PMC7754087 DOI: 10.2147/ijgm.s289015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/03/2020] [Indexed: 12/17/2022] Open
Abstract
Kounis syndrome is a rare type of acute coronary syndrome caused by coronary spasm with or without atherosclerotic plaque erosion or rupture due to inflammatory factors released by allergic reactions. Due to a lack of awareness, Kounis syndrome is often underdiagnosed. Here, we for the first time report a case of Kounis syndrome induced by anisodamine. A 48-year-old woman presented with upper abdominal pain and vomiting after eating. She was diagnosed with gastrointestinal spasm and intramuscularly injected with 10 mg anisodamine. The patient subsequently developed chest pain and hypotension with erythematous rash. A systemic allergic reaction was diagnosed. Saline solution, promethazine and dexamethasone were administered immediately. A 12-lead electrocardiogram indicated ST-segment elevation in II, III and aVF leads. Emergent coronary angiography was recommended. According to a preoperative electrocardiogram, the ST-segment elevation in the II, III and aVF leads had disappeared. Coronary angiograph revealed no significant coronary stenosis. The patient was diagnosed with Kounis syndrome induced by anisodamine, showing acute ST-segment elevation myocardial infarction due to allergic coronary vasospasm. During the 9-month follow-up, the patient did not receive further anisodamine injections and remained free of chest pain. In conclusion, it is essential for clinicians to be aware of Kounis syndrome because of the wide range of triggers and its potentially fatal evolution if not identified in time.
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Affiliation(s)
- Haoyu Wu
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an 710068, People's Republic of China
| | - Yiwei Cao
- Department of Electrocardiology, Shaanxi Provincial People's Hospital, Xi'an 710068, People's Republic of China
| | - Fengjun Chang
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an 710068, People's Republic of China
| | - Chunyan Zhang
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, People's Republic of China
| | - Yanchao Hu
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, People's Republic of China
| | - Lei Liang
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an 710068, People's Republic of China
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Vaina S, Chrysohoou C, Bonfanti L, Kounis NG, Cervellin G, Georgiopoulos G, Tousoulis D. Anaphylactic cardiovascular collapse manifesting as myocardial infarction following salad consumption. A case of Kounis variant type I syndrome. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:134-138. [PMID: 32191668 PMCID: PMC7569581 DOI: 10.23750/abm.v91i1.8176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/18/2019] [Indexed: 11/23/2022]
Abstract
Anaphylactic cardiovascular events constitute an underrated cause of medical emergencies in hospitalized patients. Coronary arteries and myocardium are targeted by anaphylactic mediators leading to acute coronary syndrome and imminent cardiovascular collapse. Early diagnosis and high clinical suspicion are required to secure prompt life-saving treatment in these cases. However, physicians of both Cardiology and Internal Medicine Departments are not familiar with this condition. Recently, we diagnosed and treated a case of anaphylactic cardiovascular collapse manifesting as acute myocardial infarction following salad consumption. Notably, Kounis anaphylaxis-associated acute coronary syndrome is a rare cause of ST segment elevation myocardial infarction with normal or diseased coronary arteries. We recommend that Kounis syndrome and its variants should be taken into consideration in the differential diagnosis of ischemic heart disease in patients with signs of allergic reaction and/or medical history of previous allergic reactions, who experience acute coronary syndrome after exposure to certain environmental stimuli. (www.actabiomedica.it)
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Affiliation(s)
- Sophia Vaina
- first Department of Cardiology, Hippokration Hospital, Athens medical School, Athens, Greece.
| | - Christina Chrysohoou
- first Department of Cardiology, Hippokration Hospital, Athens medical School, Athens, Greece.
| | - Laura Bonfanti
- Emergency Department. Academic Hospital of Parma, Italy.
| | | | | | - Georgios Georgiopoulos
- first Department of Cardiology, Hippokration Hospital, Athens medical School, Athens, Greece.
| | - Dimitris Tousoulis
- first Department of Cardiology, Hippokration Hospital, Athens medical School, Athens, Greece.
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Alataş ÖD, Alataş ET. Isotretinoin-induced pruritic erythematous lesions and acute chest pain in a 15-year-old girl. Am J Emerg Med 2019; 38:1043.e1-1043.e3. [PMID: 31784393 DOI: 10.1016/j.ajem.2019.158479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022] Open
Abstract
Isotretinoin is widely used in the treatment of acne vulgaris for more than 30 years (1). In addition to its systemic side effects, isotretinoin may also cause mucocutaneous side effects including cheilitis, nasal hemorrhage, dry skin, itching, rash, pigmented purpuric dermatosis, dry nose, purpura, and photosensitivity. We report a case of a 15-year-old girl given isotretinoin for severe acne vulgaris who developed pruritic erythematous lesions and chest pain 5 min after taking the first dose 20 mg of isotretinoin.
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Affiliation(s)
- Ömer Doğan Alataş
- Muğla University Education and Research Hospital, Department of Emergency Medicine, Turkey.
| | - Emine Tugba Alataş
- Muğla University, Faculty of Medicine, Department of Dermatology, Turkey
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Dogan V, Çelik O, Özlek B, Özlek E, Çil C, Başaran Ö, Biteker M. Allergic myocardial infarction: Type I Kounis syndrome following blue crab consumption. Acta Clin Belg 2019; 74:375-377. [PMID: 30325266 DOI: 10.1080/17843286.2018.1535927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objectives: Allergic myocardial infarction, known as Kounis syndrome, is an acute myocardial infarction after an allergic reaction to food, drugs, or insect stings, etc. Kounis syndrome can also be caused by all kinds of seafood, such as finned fish, molluscan shellfish, cephalopods, and crustacean shellfish. Methods: Herein, we report a case of a 67-year-old man, with hypertension, referred for itchiness, facial rash, chest pain, and palpitations developed after consumption of blue crab. Results: Electrocardiogram showed ST elevations in leads II,III,aVF. Transthoracic echocardiography revealed inferior wall hypokinezia with a left ventricular ejection fraction of 55%. Coronary angiography revealed no sign of atherosclerosis. The patient was diagnosed to have Kounis Syndrome type I variant, secondary to blue crab ingestion. He was treated with oral antihistamines and prednisolone.The repeated cardiac markers were within normal limits, with resolution of electrocardiographic abnormalities and inferior wall motion echocardiographic changes. Conclusion: All patients admitted to the emergency department with chest pain and ST elevation on electrocardiography should be asked about allergic insults.
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Affiliation(s)
- Volkan Dogan
- Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Muğla, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Muğla, Turkey
| | - Bülent Özlek
- Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Muğla, Turkey
| | - Eda Özlek
- Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Muğla, Turkey
| | - Cem Çil
- Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Muğla, Turkey
| | - Özcan Başaran
- Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Muğla, Turkey
| | - Murat Biteker
- Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Muğla, Turkey
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Kounis NG, Koniari I, Velissaris D, Tzanis G, Hahalis G. Kounis Syndrome—not a Single-organ Arterial Disorder but a Multisystem and Multidisciplinary Disease. Balkan Med J 2019; 36:212-221. [PMID: 31198019 PMCID: PMC6636655 DOI: 10.4274/balkanmedj.galenos.2019.2019.5.62] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Coronary symptoms associated with conditions related to mast cell activation and inflammatory cell interactions, such as those involving T-lymphocytes and macrophages, further inducing allergic, hypersensitivity, anaphylactic, or anaphylactic insults, are currently referred to as the Kounis syndrome. Kounis syndrome is caused by inflammatory mediators released during allergic insults, post-inflammatory cell activation, and interactions via multidirectional stimuli. A platelet subset of 20% with high- and low-affinity IgE surface receptors is also involved in this process. Kounis syndrome is not just a single-organ but also a complex multisystem and multi-organ arterial clinical condition; it affects the coronary, mesenteric, and cerebral arteries and is accompanied by allergy–hypersensitivity–anaphylaxis involving the skin, respiratory, and vascular systems in the context of anesthesia, surgery, radiology, oncology, or even dental and psychiatric medicine; further, it has significantly influences both morbidity and mortality. Kounis syndrome might be caused by numerous and continuously increasing causes, with broad clinical symptoms and signs, via multi-organ arterial system involvement, in patients of any age, thereby demonstrating predominant anaphylactic features in terms of a wide spectrum of mast cell-association disorders. Cardiac symptoms, such as chest pain, coronary vasospasm, angina pectoris, myocardial infarction, stent thrombosis, acute cardiac failure, and sudden cardiac death associated with subclinical, clinical, acute, or chronic allergic reactions, constitute the clinical manifestations of this syndrome. Since its first description, a common pathway between allergic and non-allergic coronary events has been demonstrated. The hypothesis is based on the existence of a much higher degree of mast cell degranulation at plaque erosion or rupture sites compared with at the adjacent areas or even more distant segments in post-acute myocardial infarction of non-allergic etiology. Although mast cell activation, differentiation, and mediator release takes days or weeks, the mast cell degranulation may occur just before any acute coronary event, further resulting in coronary artery vasoconstriction and atheromatous plaque rupture. It seems that medications and natural molecules stabilizing the mast cell membrane as well as monoclonal antibodies protecting the mast cell surface can emerge as novel therapeutic modalities for acute coronary and cerebrovascular event prevention.
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Affiliation(s)
- Nicholas G. Kounis
- Department of Cardiology, Patras University School of Medicine, Patras, Greece
| | - Ioanna Koniari
- Electrophysiology and Device Department University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Dimitrios Velissaris
- Department of Internal Medicine, Patras University School of Medicine, Patras, Greece
| | - George Tzanis
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Via Madonna di Genova, Cotignola RA, Italy
| | - George Hahalis
- Department of Cardiology, Patras University School of Medicine, Patras, Greece
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Gemifloxacin-Induced Allergic Myocardial Infarction: A Case Report. J Emerg Med 2019; 56:e103-e105. [PMID: 31003822 DOI: 10.1016/j.jemermed.2019.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 02/09/2019] [Accepted: 03/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gemifloxacin given once daily for 5-7 days has been shown to be non-inferior to, or in some instances superior to, comparator agents for the treatment of common lower respiratory tract infections. Gemifloxacin is generally well tolerated and is as safe as many frequently empirically prescribed antimicrobials. CASE REPORT We report a case of a 46-year-old woman given gemifloxacin for an upper respiratory tract infection who developed allergic myocardial infarction 15 min after taking an oral dose of 320 mg gemifloxacin. To our knowledge, this is the first case of allergic myocardial infarction associated with gemifloxacin. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although anaphylactoid/anaphylactic reactions are rare adverse effects of fluoroquinolones, clinicians should be aware of this potentially fatal event. Electrocardiographic interpretation is a critical skill of the emergency physician. Awareness of Kounis syndrome and its specific electrocardiogram findings may help facilitate further testing that will aid in timely diagnosis and interventions. A diagnosis of Kounis syndrome should be considered in young, healthy patients with no atherosclerotic risk factors when they develop an acute coronary syndrome after administration of a potentially allergic agent.
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Tripolino C, Tassone EJ, Morabito G, Grillo P, Missiroli B. Acute coronary stent thrombosis: A case of type 3 Kounis syndrome. J Cardiol Cases 2019; 19:33-35. [PMID: 30693057 DOI: 10.1016/j.jccase.2018.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/24/2018] [Accepted: 09/26/2018] [Indexed: 12/26/2022] Open
Abstract
Kounis syndrome refers to an acute coronary syndrome, consequent to an allergic reaction. It results from mast cell degranulation with subsequent release of numerous inflammatory mediators, leading to coronary vasospasm, atheromatous plaque rupture, or stent thrombosis. Here, we describe the case of a 47-year-old Caucasian man with acute stent thrombosis, as a consequence of allergic reaction to contrast media. <Learning objective: Kounis syndrome is an acute coronary syndrome, consequent to an allergic reaction. Cytokine release might precipitate coronary spasm, plaque rupture, or stent thrombosis. Stent thrombosis is a dramatic complication of coronary stenting, presenting as sudden death or acute myocardial infarction. Our case serves as an example for clinicians to consider the possibility of Kounis syndrome in patients with acute coronary syndrome and anaphylaxis in order to ensure appropriate treatment.>.
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Lambert K, Tse R, Tettamanti C, Scarpelli MP, Rousseau G, Bonsignore A, Palmiere C. Postmortem IgE determination in coronary artery disease. J Forensic Leg Med 2019; 62:1-6. [PMID: 30599216 DOI: 10.1016/j.jflm.2018.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/12/2018] [Accepted: 12/20/2018] [Indexed: 01/08/2023]
Abstract
Allergic, IgE-mediated inflammation is thought to play a role in atherogenesis and atherosclerotic disease progression. In this study, total IgE and mast cell tryptase were measured in a series of forensic autopsy cases including non-allergic cardiac deaths (14 cases with minimal or no coronary atherosclerosis, 14 cases with significant coronary artery atherosclerosis without acute coronary thrombosis, and 14 cases with significant coronary artery atherosclerosis and acute coronary thrombosis or myocardial infarction) and non-allergic non-cardiac deaths (21 cases with death due to hanging and 21 cases with death due to intracranial gunshot wounds), in order to correlate laboratory results with morphological findings and compare them to conclusions reported in the clinical setting. In cardiac death cases, postmortem serum total IgE levels were increased in 7 out of 42 cases and mast cell tryptase levels were increased in 3 out of 42 cases. In non-cardiac death cases, postmortem serum total IgE levels were not increased in 39 out of 42 cases and mast cell tryptase levels were not increased in any of these cases. These preliminary findings seem to indicate that a portion of coronary deaths characterized by coronary artery atherosclerosis of various severities are also characterized by increased total IgE and mast cell tryptase levels, thus corroborating the data previously reported in both clinical and forensic literature on this topic as well as the necessity of combining morphological investigations focusing on the heart and coronary arteries with biochemical analyses.
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Affiliation(s)
- Karine Lambert
- CURML, Centre Universitaire Romand de Médecine Légale, Lausanne University Hospital, Chemin de La Vulliette 4, 1000, Lausanne 25, Switzerland
| | - Rexson Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, 1148, New Zealand
| | - Camilla Tettamanti
- Departmental Section of Forensic and Legal Medicine and School of Specialization in Legal Medicine, University of Genova, Via de Toni 12, 16132, Genova, Italy
| | - Maria Pia Scarpelli
- CURML, Centre Universitaire Romand de Médecine Légale, Lausanne University Hospital, Chemin de La Vulliette 4, 1000, Lausanne 25, Switzerland
| | - Guillaume Rousseau
- Département de Biochimie et Génétique, Centre Hospitalier Universitaire D'Angers, Angers, France; Service de Médecine Légale et Pénitentiaire, Centre Hospitalier Universitaire D'Angers, Angers, France
| | - Alessandro Bonsignore
- Departmental Section of Forensic and Legal Medicine and School of Specialization in Legal Medicine, University of Genova, Via de Toni 12, 16132, Genova, Italy
| | - Cristian Palmiere
- CURML, Centre Universitaire Romand de Médecine Légale, Lausanne University Hospital, Chemin de La Vulliette 4, 1000, Lausanne 25, Switzerland.
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A case of Kounis syndrome associated with branched-chain amino acid supplementation in a 17-year-old boy. Cardiol Young 2018; 28:1165-1167. [PMID: 30047352 DOI: 10.1017/s104795111800104x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Kounis Syndrome is characterised by the concurrence of acute coronary syndrome with mast cell activation induced by inflammatory mediators released during an allergic reaction. Although several factors and diseases were reported to be associated with Kounis Syndrome, branched-chain amino acid supplements have not been previously reported as a cause of Kounis Syndrome. We present a 17-year-old boy admitted to our hospital with thoracic pain after the ingestion of a branched-chain amino acid supplement.
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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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Okuno A, Matsuki Y, Tabata M, Shigemi K. A suspected case of coronary vasospasm induced by anaphylactic shock caused by rocuronium-sugammadex complex. J Clin Anesth 2018; 48:7. [DOI: 10.1016/j.jclinane.2018.03.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 03/09/2018] [Accepted: 03/19/2018] [Indexed: 11/28/2022]
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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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Özlek B, Özlek E, Çelik O, Çil C, Doğan V, Biteker M. Allergic myocardial infarction following recombinant human insulin. Heart Lung 2018; 47:360-362. [PMID: 29709318 DOI: 10.1016/j.hrtlng.2018.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/30/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Allergic myocardial infarction is a rare clinical entity. OBJECTIVES Although a few number of case reports with severe anaphylactic reactions to recombinant human insulin have been reported, allergic myocardial infarction, known as Kounis Syndrome, has not been reported before. METHODS Herein, we report a 57-year-old woman with myocardial infarction, referred for urticarial rash, chest pain, and palpitations developed after the first subcutaneous dose of recombinant human insulin. RESULTS The patient treated with antihistamines and steroids and discharged from hospital in a good condition. CONCLUSIONS Physicians should be aware of allergic myocardial infarction. The diagnosis of Kounis Syndrome should be entertained when allergic symptoms, electrocardiographic changes, and high cardiac enzymes accompany acute-onset chest pain. All patients admitted to the emergency department with chest pain and ST elevation on electrocardiography should be asked about allergic insults.
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Affiliation(s)
- Bülent Özlek
- Muğla University, Faculty of Medicine, Department of Cardiology, Muğla, Turkey.
| | - Eda Özlek
- Muğla University, Faculty of Medicine, Department of Cardiology, Muğla, Turkey
| | - Oğuzhan Çelik
- Muğla University, Faculty of Medicine, Department of Cardiology, Muğla, Turkey
| | - Cem Çil
- Muğla University, Faculty of Medicine, Department of Cardiology, Muğla, Turkey
| | - Volkan Doğan
- Muğla University, Faculty of Medicine, Department of Cardiology, Muğla, Turkey
| | - Murat Biteker
- Muğla University, Faculty of Medicine, Department of Cardiology, Muğla, Turkey
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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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Kounis syndrome type I in a victim of cardiopulmonary arrest after hymenoptera sting. J Cardiol Cases 2017; 15:141-144. [DOI: 10.1016/j.jccase.2016.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/29/2016] [Accepted: 12/22/2016] [Indexed: 11/18/2022] Open
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Kounis syndrome: A review article on epidemiology, diagnostic findings, management and complications of allergic acute coronary syndrome. Int J Cardiol 2017; 232:1-4. [DOI: 10.1016/j.ijcard.2017.01.124] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 12/30/2016] [Accepted: 01/26/2017] [Indexed: 02/07/2023]
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Acute myocardial infarction in a patient suffering from penicillin-induced laryngeal edema : Kounis syndrome aggravated by adrenaline. Wien Klin Wochenschr 2017; 129:509-511. [PMID: 28255796 DOI: 10.1007/s00508-017-1183-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
Abstract
Kounis syndrome or allergic angina is defined as the coincidental occurrence of chest pain and allergic reactions accompanied by clinical and laboratory findings of classical angina pectoris. It is triggered by the action of potent vasoactive and inflammatory mediators, which are released from the mast cells during the allergic reaction. Epinephrine is a life-saving medication in anaphylaxis; however, it can aggravate ischemia and induce coronary vasospasm and arrhythmias. Here, we present a patient with Kounis syndrome that was caused by intramuscular injection of procaine penicillin G, and in whom epinephrine administration for treatment of laryngeal edema had provoked severe myocardial ischemia.
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An Unusual Case of Recurrent Hypersensitivity Reaction Associated with Kounis-Like Acute Coronary Syndrome. Case Rep Cardiol 2017; 2017:6421208. [PMID: 28928989 PMCID: PMC5591985 DOI: 10.1155/2017/6421208] [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: 05/08/2017] [Accepted: 07/19/2017] [Indexed: 11/17/2022] Open
Abstract
There have been multiple reports of allergic reactions associated with acute coronary syndromes. This has been classically described as Kounis syndrome. We present an unusual case of 70-year-old male with multiple prior hypersensitivity reactions and history of coronary artery bypass grafting who presented recurrent episode of severe angioedema and anaphylaxis. He responded to epinephrine but subsequently developed a non-ST elevation myocardial infarction with worsening heart failure. Our case is unique in that, unlike classic Kounis syndrome, the acute coronary event in this case did not present concurrently with the allergic reaction; rather it took nearly 48 hours to present. Subsequent angiogram revealed patent grafts and significant decline in the left ventricular systolic function as compared to his own ECHO a year ago. We postulate that slow mediators of inflammation may play a role in delayed development of acute coronary events with associated LV dysfunction following episodes of angioedema and anaphylaxis.
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Almeida J, Ferreira S, Malheiro J, Fonseca P, Caeiro D, Dias A, Ribeiro J, Gama V. A rare cause of acute coronary syndrome: Kounis syndrome. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2016.03.011] [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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Almeida J, Ferreira S, Malheiro J, Fonseca P, Caeiro D, Dias A, Ribeiro J, Gama V. A rare cause of acute coronary syndrome: Kounis syndrome. Rev Port Cardiol 2016; 35:699.e1-699.e4. [PMID: 27865673 DOI: 10.1016/j.repc.2016.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/20/2016] [Accepted: 03/08/2016] [Indexed: 10/20/2022] Open
Abstract
Kounis syndrome is an acute coronary syndrome in the context of a hypersensitivity reaction. The main pathophysiological mechanism appears to be coronary vasospasm. We report the case of a patient with a history of allergy to quinolones, who was given ciprofloxacin before an elective surgical procedure and during drug administration developed symptoms and electrocardiographic changes suggestive of ST-segment elevation acute coronary syndrome. The drug was suspended and coronary angiography excluded epicardial coronary disease. Two hours after withdrawal of the drug the symptoms and ST elevation had resolved completely.
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Affiliation(s)
- João Almeida
- Serviço de Cardiologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
| | - Sara Ferreira
- Serviço de Cardiologia, Hospital Divino Espírito Santo, Ponta Delgada, Portugal
| | - Joana Malheiro
- Serviço de Medicina Interna, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Paulo Fonseca
- Serviço de Cardiologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Daniel Caeiro
- Serviço de Cardiologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Adelaide Dias
- Serviço de Cardiologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - José Ribeiro
- Serviço de Cardiologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Vasco Gama
- Serviço de Cardiologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Kounis syndrome with cardiogenic shock during transfemoral transcatheter aortic valve replacement. Coron Artery Dis 2016; 26:726-7. [PMID: 26398150 DOI: 10.1097/mca.0000000000000300] [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] [Indexed: 11/26/2022]
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Mast cell activation disease and the modern epidemic of chronic inflammatory disease. Transl Res 2016; 174:33-59. [PMID: 26850903 DOI: 10.1016/j.trsl.2016.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 01/07/2016] [Accepted: 01/08/2016] [Indexed: 12/18/2022]
Abstract
A large and growing portion of the human population, especially in developed countries, suffers 1 or more chronic, often quite burdensome ailments which either are overtly inflammatory in nature or are suspected to be of inflammatory origin, but for which investigations to date have failed to identify specific causes, let alone unifying mechanisms underlying the multiple such ailments that often afflict such patients. Relatively recently described as a non-neoplastic cousin of the rare hematologic disease mastocytosis, mast cell (MC) activation syndrome-suspected to be of greatly heterogeneous, complex acquired clonality in many cases-is a potential underlying/unifying explanation for a diverse assortment of inflammatory ailments. A brief review of MC biology and how aberrant primary MC activation might lead to such a vast range of illness is presented.
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Kounis syndrome: Acute myocardial injury caused by multiple bee stings. Med J Armed Forces India 2016; 72:S178-S181. [PMID: 28050107 DOI: 10.1016/j.mjafi.2016.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 04/13/2016] [Indexed: 11/20/2022] Open
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A Wasp Sting and a Broken Heart. Wilderness Environ Med 2016; 27:326-9. [DOI: 10.1016/j.wem.2015.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 11/26/2015] [Accepted: 12/03/2015] [Indexed: 11/21/2022]
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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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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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Kounis NG. Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management. ACTA ACUST UNITED AC 2016; 54:1545-59. [DOI: 10.1515/cclm-2016-0010] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/03/2016] [Indexed: 12/14/2022]
Abstract
AbstractKounis syndrome has been established as a hypersensitivity coronary disorder induced by various conditions, drugs, environmental exposures, foods and coronary stents. Allergic, hypersensitivity, anaphylactic and anaphylactoid reactions are associated with this syndrome. Vasospastic allergic angina, allergic myocardial infarction and stent thrombosis with occluding thrombus infiltrated by eosinophils and/or mast cells constitute are the three reported, so far, variants of this syndrome. Apart from coronary arteries, it affects the cerebral and mesenteric arteries. Its manifestations are broadening and its etiology is continuously increasing. Kounis syndrome is a ubiquitous disease which represents a magnificent natural paradigm and nature’s own experiment in a final trigger pathway implicated in cases of coronary artery spasm and plaque rupture. Kounis syndrome seems to be not a rare disease but an infrequently diagnosed clinical entity which has revealed that the same mediators released from the same inflammatory cells are also present and in acute coronary events of non allergic etiology. These cells are not only present in the culprit region before plaque erosion or rupture but they release their contents just before an actual coronary event. Therefore, awareness of etiology, epidemiology, pathogenesis and clinical manifestations seems to be important for its prognosis, diagnosis, treatment, prevention.
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Liping Z, Bin H, Qiming F. An Extraordinary Case Associated with an Allergic Reaction to Clopidogrel: Coronary Artery Spasm or Kounis Syndrome? Heart Lung Circ 2015; 24:e180-3. [DOI: 10.1016/j.hlc.2015.04.183] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 04/22/2015] [Accepted: 04/25/2015] [Indexed: 11/27/2022]
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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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