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Krishnamoorthy S, Kaur R, Ameer N, Uzoma AA, Enemuo NR, Gopal S, Glenn V. Type I Kounis Syndrome: Allergic Myocardial Infarction Triggered by Ciprofloxacin. Cureus 2024; 16:e62460. [PMID: 39015853 PMCID: PMC11250056 DOI: 10.7759/cureus.62460] [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: 06/14/2024] [Indexed: 07/18/2024] Open
Abstract
Kounis syndrome (KS), known as allergic myocardial infarction (MI), is an uncommon but potentially life-threatening disease characterized by acute coronary artery disease (CAD) in the setting of allergic reactions. KS is most frequently triggered by medication, and ciprofloxacin-induced KS-I is rarely reported. Here, we present a case of KS-I triggered by ciprofloxacin in a young female with no prior CAD. A 35-year-old female presented with sudden onset chest pain, diaphoresis, and lightheadedness, accompanied by itching, confusion, and collapse, shortly after taking oral ciprofloxacin. Her electrocardiogram showed inferior wall MI with elevated cardiac troponin levels. Urgent coronary angiography was unremarkable. Her condition improved after sublingual nitroglycerine, methylprednisolone, and intramuscular injection of epinephrine. This case highlights the importance of recognizing drug-induced allergic reactions as a potential cause of acute coronary events, particularly in young patients without traditional risk factors.
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Affiliation(s)
| | - Rashpinder Kaur
- Microbiology, Kalpana Chawla Government Medical College, Karnal, IND
| | - Nazeera Ameer
- General Practice, K S Hegde Medical Academy, Mangaluru, IND
| | - Amarachi A Uzoma
- Family Medicine, Kharkiv National Medical University, Kharkiv, UKR
| | - Nkechi R Enemuo
- Internal Medicine, College of Medicine, University of Ibadan, Ibadan, NGA
| | - Shwetha Gopal
- Cardiovascular Disease, Bassett Medical Center, Cooperstown, USA
| | - Vernice Glenn
- Internal Medicine, Saint James School of Medicine, Arnos Vale, VCT
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2
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Ceasovschih A, Șorodoc V, Covantsev S, Balta A, Uzokov J, Kaiser SE, Almaghraby A, Lionte C, Stătescu C, Sascău RA, Onofrei V, Haliga RE, Stoica A, Bologa C, Ailoaei Ș, Şener YZ, Kounis NG, Șorodoc L. Electrocardiogram Features in Non-Cardiac Diseases: From Mechanisms to Practical Aspects. J Multidiscip Healthc 2024; 17:1695-1719. [PMID: 38659633 PMCID: PMC11041971 DOI: 10.2147/jmdh.s445549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/10/2024] [Indexed: 04/26/2024] Open
Abstract
Despite the noteworthy advancements and the introduction of new technologies in diagnostic tools for cardiovascular disorders, the electrocardiogram (ECG) remains a reliable, easily accessible, and affordable tool to use. In addition to its crucial role in cardiac emergencies, ECG can be considered a very useful ancillary tool for the diagnosis of many non-cardiac diseases as well. In this narrative review, we aimed to explore the potential contributions of ECG for the diagnosis of non-cardiac diseases such as stroke, migraine, pancreatitis, Kounis syndrome, hypothermia, esophageal disorders, pulmonary embolism, pulmonary diseases, electrolyte disturbances, anemia, coronavirus disease 2019, different intoxications and pregnancy.
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Affiliation(s)
- Alexandr Ceasovschih
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Victorița Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Serghei Covantsev
- Department of Research and Clinical Development, Botkin Hospital, Moscow, Russia
| | - Anastasia Balta
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Jamol Uzokov
- Department of Cardiology, Republican Specialized Scientific Practical Medical Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan
| | - Sergio E Kaiser
- Discipline of Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Abdallah Almaghraby
- Department of Cardiology, Ibrahim Bin Hamad Obaidallah Hospital, Ras Al Khaimah, United Arab Emirates
| | - Cătălina Lionte
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Cristian Stătescu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Radu A Sascău
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Viviana Onofrei
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Raluca Ecaterina Haliga
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Alexandra Stoica
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Cristina Bologa
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Ștefan Ailoaei
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Yusuf Ziya Şener
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Nicholas G Kounis
- Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, Patras, Greece
| | - Laurențiu Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
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3
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Chang HW, Ahn S, Kim JS, Han HJ, Park YK, Kim KM, Kim SY, Jung JC, Lee JH, Kim DJ, Lim C, Park K. Influence of Preoperative COVID-19 Vaccination on Outcomes After Coronary Artery Bypass Grafting-A Propensity Score-Matched Analysis. J Am Heart Assoc 2024; 13:e032426. [PMID: 38471836 PMCID: PMC11010012 DOI: 10.1161/jaha.123.032426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/02/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Reports of intravascular thrombosis and cardiac complications have raised concerns about the safety of COVID-19 vaccinations, particularly in patients with high cardiovascular risk. Herein, we aimed to analyze the impact of preoperative COVID-19 vaccination on outcomes after coronary artery bypass grafting (CABG). METHODS AND RESULTS Among 520 patients who underwent isolated CABG from 2020 to 2022, 481 patients (mean±SD age: 67±11 years, 86 women) whose COVID-19 vaccination status could be confirmed were included. A total of 249 patients who had not received any COVID-19 vaccine before CABG (never vaccinated group) and 214 patients who had completed primary vaccination (fully vaccinated group) were subjected to 1:1 propensity score matching, and 156 pairs of patients were matched. There was no significant difference in early mortality between the 2 groups after matching. After matching, overall survival (P=0.930) and major adverse cardiovascular and cerebrovascular event-free survival (P=0.636) did not differ between the 2 groups. One-year graft patency also did not differ significantly between the 2 groups; all patent grafts in 85/104 patients (82%) and 62/73 patients (85%) in the never vaccinated and fully vaccinated groups, respectively (P=0.685). Subgroup analysis showed equivalent overall and major adverse cardiovascular and cerebrovascular event-free survival among AstraZeneca and Pfizer vaccine recipients and between those with ≤30 days versus >30 days from vaccination to CABG. CONCLUSIONS Despite the very high cardiovascular risk for patients undergoing CABG, COVID-19 vaccination did not affect major outcomes after CABG. Therefore, there is no reason for patients with coronary artery disease requiring CABG to avoid preoperative COVID-19 vaccination.
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Affiliation(s)
- Hyoung Woo Chang
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Soyeon Ahn
- Biostatistics, Medical Research Collaborating CenterSeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Jun Sung Kim
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Hyun Jeong Han
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - You Kyeong Park
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Kang Min Kim
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Sang Yoon Kim
- Department of Thoracic and Cardiovascular SurgeryChungnam National University HospitalDaejeonRepublic of Korea
| | - Joon Chul Jung
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Jae Hang Lee
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Dong Jung Kim
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Kay‐Hyun Park
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
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Greene S, Gilbert M, Wolk B, Campleman S, Ruha AM. Geographic variation in the clinical features of Mohave rattlesnake ( Crotalus scutulatus) envenomations reported to the North American Snakebite Registry. Toxicon X 2024; 21:100171. [PMID: 38047156 PMCID: PMC10689943 DOI: 10.1016/j.toxcx.2023.100171] [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: 07/15/2023] [Revised: 09/04/2023] [Accepted: 10/25/2023] [Indexed: 12/05/2023] Open
Abstract
The geographic variation of Mohave rattlesnake (Crotalus scutulatus) venom is well established. We reviewed all the Mohave rattlesnake bites reported to the Toxicology Investigators Consortium's North American Snakebite Registry between January 1, 2015 and 12/31/2021. Data reviewed for this study included details regarding the snake encounter, patient demographics, signs and symptoms, treatment, and outcomes. Our objective was to describe the epidemiology, clinical manifestations, and management of Mohave rattlesnake envenomations using prospective data from two geographically distinct sites. There were 20 subjects, including eight nonpregnant females. Ages ranged from seven to 75 years, median age 48. Nine of the bites were managed in Arizona and 11 in California. In Arizona, all envenomated patients had local swelling. None had neurological toxicity. In California, swelling was present in nine patients. Neurological effects were observed in five subjects. Four Arizona patients and one California patient had hypotension requiring treatment. Each site had one patient with thrombocytopenia. An Arizona patient who sustained a bite to the face was intubated. Rhabdomyolysis occurred in two California patients. All envenomated patients received antivenom. Mohave rattlesnakes have the potential to cause significant local and/or systemic toxicity. Neurotoxicity was not observed in envenomations from Mohave rattlesnakes that presumably lack Mohave toxin, but hypotension and gastrointestinal signs were more common than in bites from snakes believed to possess Mohave toxin. Neurological toxicity was limited to paresthesias and fasciculations. Significant skeletal or respiratory muscle weakness was not observed in our study population.
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Affiliation(s)
- Spencer Greene
- University of Houston/HCA Kingwood Emergency Medicine Residency Program, Kingwood, TX, USA
| | - Matthew Gilbert
- University of Houston/HCA Kingwood Emergency Medicine Residency Program, Kingwood, TX, USA
| | - Brian Wolk
- Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | | | - Anne-Michelle Ruha
- Department of Medical Toxicology, Banner University Medical Center – Phoenix, Phoenix, AZ, USA
| | - on behalf of the ToxIC Snakebite Study Group
- University of Houston/HCA Kingwood Emergency Medicine Residency Program, Kingwood, TX, USA
- Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
- American College of Medical Toxicology, Phoenix, AZ, USA
- Department of Medical Toxicology, Banner University Medical Center – Phoenix, Phoenix, AZ, USA
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5
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Eftekhar Z, Haybar H, Mohebbi A, Saki N. Cardiac Complications and COVID-19: A Review of Life-threatening Co-morbidities. Curr Cardiol Rev 2024; 20:1-12. [PMID: 38415433 DOI: 10.2174/011573403x279782240206091322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/23/2023] [Accepted: 01/19/2024] [Indexed: 02/29/2024] Open
Abstract
The novel 2019 coronavirus disease (COVID-19) was first reported in the last days of December 2019 in Wuhan, China. The presence of certain co-morbidities, including cardiovascular diseases (CVDs), are the basis for worse outcomes in patients with COVID-19. Relevant English-language literature was searched and retrieved from the Google Scholar search engine and PubMed database up to 2023 using COVID-19, SARS-CoV-2, Heart failure, Myocardial infarction, and Arrhythmia and Cardiac complication as keywords. Increased hemodynamic load, ischemia-related dysfunction, ventricular remodeling, excessive neurohumoral stimulation, abnormal myocyte calcium cycling, and excessive or insufficient extracellular matrix proliferation are associated with heart failure (HF) in COVID-19 patients. Inflammatory reaction due to the excessive release of inflammatory cytokines, leads to myocardial infarction (MI) in these patients. The virus can induce heart arrhythmia through cardiac complications, hypoxia, decreased heart hemodynamics, and remarkable inflammatory markers. Moreover, studies have linked cardiac complications in COVID-19 with poor outcomes, extended hospitalization time, and increased mortality rate. Patients with COVID-19 and CVDs are at higher mortality risk and they should be given high priority when receiving the treatment and intensive care during hospitalization.
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Affiliation(s)
- Zeinab Eftekhar
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Habib Haybar
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Mohebbi
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Najmaldin Saki
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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6
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Erdem A, Çınar T, Kılıç Ş, Öztürk NB. Unexpected cause of Kounis syndrome: hypersensitivity reaction to omeprazole. BMJ Case Rep 2023; 16:e254799. [PMID: 37879707 PMCID: PMC10603422 DOI: 10.1136/bcr-2023-254799] [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] [Indexed: 10/27/2023] Open
Abstract
Kounis syndrome is a rare type of acute coronary syndrome (ACS) that occurs as a result of an allergic or anaphylactic reaction. Kounis syndrome can be induced by various medications including antibiotics, proton pump inhibitors, antihypertensive medications, corticosteroids, and antineoplastic medications. Additionally, cases of Kounis syndrome associated with lansoprazole and pantoprazole have been previously reported in the literature. In this report, we present a case of Kounis syndrome associated with omeprazole use, and discuss the need for a high index of suspicion as it is often underrecognised.
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Affiliation(s)
- Almina Erdem
- Cardiology, Istanbul Sultan II Abdulhamid Han Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Tufan Çınar
- İnternal Medicine, University of Maryland Midtown Campus, Baltimore, Maryland, USA
| | - Şahhan Kılıç
- Cardiology, Istanbul Sultan II Abdulhamid Han Egitim ve Arastirma Hastanesi, Istanbul, Turkey
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7
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Kounis NG, Mplani V, Gogos C. Acute Myocardial Infarction and Emotional Distress: A Magnificent Biologic Pathway. Am J Cardiol 2023; 205:520. [PMID: 37633795 DOI: 10.1016/j.amjcard.2023.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/28/2023]
Affiliation(s)
| | - Virginia Mplani
- Intensive Care Unit, University Hospital of Patras, Patras, Greece
| | - Christos Gogos
- Department of Cardiology, Papageorgiou General Hospital, Nea Efkarpia, Thessaloniki, Greece; First University Cardiology Department, American Hellenic Educational Progressive Association General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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8
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Obata A, Saito-Sasaki N, Sugino H, Itamura M, Okada E, Sawada Y. Cardiac Arrest Due to Kounis Syndrome Following Cephazolin Administration During Surgery Under Local Anesthesia. Cureus 2023; 15:e46297. [PMID: 37915873 PMCID: PMC10616681 DOI: 10.7759/cureus.46297] [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: 09/30/2023] [Indexed: 11/03/2023] Open
Abstract
The Kounis syndrome is described as the co-occurrence of allergic responses brought on by mast cell activation and acute coronary syndromes. We present a case of Kounis syndrome leading to cardiac arrest following the cephazolin sodium administration during the surgical resection of basal cell carcinoma. An 87-year-old woman was diagnosed with basal cell cancer. She received surgical excision of the tumor while anesthetized with lidocaine hydrochloride and 1% epinephrine. This patient began to itch around five minutes after cefazolin (CEZ) administration and eventually experienced cardiac arrest following diffuse rashes that spread throughout her body and edema in her eyelids. In line with the response, the electrocardiogram (ECG) also showed an elevated ST segment in V1-6, leading to possibly the diagnosis of Kounis syndrome. We also review the literature on Kounis syndrome following CEZ administration.
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Affiliation(s)
- Ayaka Obata
- Dermatology, University of Occupational and Environmental Health, Kitakyushu, JPN
| | - Natsuko Saito-Sasaki
- Dermatology, University of Occupational and Environmental Health, Kitakyushu, JPN
| | - Hitomi Sugino
- Dermatology, University of Occupational and Environmental Health, Kitakyushu, JPN
| | - Misa Itamura
- Dermatology, University of Occupational and Environmental Health, Kitakyushu, JPN
| | - Etsuko Okada
- Dermatology, University of Occupational and Environmental Health, Kitakyushu, JPN
| | - Yu Sawada
- Dermatology, University of Occupational and Environmental Health, Kitakyushu, JPN
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9
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Takeuchi S, Miyauchi M, Kadota T, Fukuda M, Nishiyama K. Cerebral infarction after anaphylactic shock due to cold-induced urticaria. QJM 2023; 116:461-462. [PMID: 36786405 PMCID: PMC10250077 DOI: 10.1093/qjmed/hcad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Indexed: 02/15/2023] Open
Affiliation(s)
- S Takeuchi
- From the Department of Disaster and Emergency Medicine, Kochi Medical School, Nankoku-city, Kochi, Japan
| | - M Miyauchi
- From the Department of Disaster and Emergency Medicine, Kochi Medical School, Nankoku-city, Kochi, Japan
| | - T Kadota
- From the Department of Disaster and Emergency Medicine, Kochi Medical School, Nankoku-city, Kochi, Japan
| | - M Fukuda
- Department of Neurosurgery, Kochi Health Sciences Center, Kochi-city, Kochi, Japan
| | - K Nishiyama
- From the Department of Disaster and Emergency Medicine, Kochi Medical School, Nankoku-city, Kochi, Japan
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10
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Aye YN, Mai AS, Zhang A, Lim OZH, Lin N, Ng CH, Chan MY, Yip J, Loh PH, Chew NWS. Acute myocardial infarction and myocarditis following COVID-19 vaccination. QJM 2023; 116:279-283. [PMID: 34586408 PMCID: PMC8522388 DOI: 10.1093/qjmed/hcab252] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 09/23/2021] [Indexed: 12/30/2022] Open
Abstract
Emerging reports raise concerns on the potential association between the COVID-19 vaccines and cardiac manifestations. We sought to evaluate cardiac complications associated with COVID-19 vaccination in a pooled analysis from our institution's cohort study and systematic review. Consecutive patients admitted to a tertiary hospital in Singapore between 1 January 2021 and 31 March 2021, with the onset of cardiac manifestations within 14 days following COVID-19 vaccination, were studied. Furthermore, a systematic review was performed, with PubMed, Embase, Research Square, MedRxiv and LitCovid databases accessed from inception up to 29 June 2021. Relevant manuscripts reporting individual patient data on cardiac complications following COVID-19 vaccination were included. Thirty patients were included in the study cohort, with 29 diagnosed with acute myocardial infarction (AMI) and 1 with myocarditis. Five patients developed heart failure, two had cardiogenic shock, three intubated, and one had cardiovascular-related mortality. In the systematic review, 16 studies were included with 41 myocarditis and 6 AMI cases. In the pooled analysis of the study cohort and the systematic review, 35 patients had AMI and 42 had myocarditis. Majority were men, and myocarditis patients were younger than AMI patients. Myocarditis patients tended to present 72 h postvaccination, while AMI patients were older and typically presented 24 h postvaccination. Majority with AMI or myocarditis developed symptoms after the first and second vaccination dose, respectively. This pooled analysis of patients presenting with cardiac manifestations following COVID-19 vaccination highlights the differences between myocarditis and AMI presentations in temporal association with the vaccination.
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Affiliation(s)
- Y N Aye
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - A S Mai
- Yong Loo Lin School of Medicine. Singapore 117597
| | - A Zhang
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - O Z H Lim
- Yong Loo Lin School of Medicine. Singapore 117597
| | - N Lin
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - C H Ng
- Yong Loo Lin School of Medicine. Singapore 117597
| | - M Y Chan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine. Singapore 117597
| | - J Yip
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine. Singapore 117597
| | - P -H Loh
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine. Singapore 117597
| | - N W S Chew
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
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11
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Hubbard JA, Wolfe RC. Perioperative Considerations in Patients With Mast Cell Activation Syndrome. J Perianesth Nurs 2023; 38:357-360. [PMID: 36828701 DOI: 10.1016/j.jopan.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Julie A Hubbard
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO
| | - Rachel C Wolfe
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO.
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12
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Zhang AA, Chew NWS. Reply to 'Letter to the Editor: Acute hypersensitivity myocardial infarction (Kounis syndrome) and hypersensitivity myocarditis following COVID-19 vaccine vaccination'. QJM 2023; 116:83-84. [PMID: 35134209 PMCID: PMC9383391 DOI: 10.1093/qjmed/hcac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- A A Zhang
- From the Department of Cardiology, National University Heart Centre Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228, Singapore
| | - N W S Chew
- Address correspondence to Dr N.W.S. Chew, Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228, Singapore.
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13
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Moreau A, Gouel-Chéron A, Roland E, McGee K, Plaud B, Blet A. Allergie peranesthésique : revue et guide de bonnes pratiques. ANESTHÉSIE & RÉANIMATION 2023. [DOI: 10.1016/j.anrea.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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14
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Restrepo MI, Marin-Corral J, Rodriguez JJ, Restrepo V, Cavallazzi R. Cardiovascular Complications in Coronavirus Disease 2019-Pathogenesis and Management. Semin Respir Crit Care Med 2023; 44:21-34. [PMID: 36646083 DOI: 10.1055/s-0042-1760096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused a devastating impact on morbidity and mortality around the world. Severe acute respiratory syndrome-coronavirus-2 has a characteristic tropism for the cardiovascular system by entering the host cells and binding to angiotensin-converting enzyme 2 receptors, which are expressed in different cells, particularly endothelial cells. This endothelial injury is linked by a direct intracellular viral invasion leading to inflammation, microthrombosis, and angiogenesis. COVID-19 has been associated with acute myocarditis, cardiac arrhythmias, new onset or worsening heart failure, ischemic heart disease, stroke, and thromboembolic disease. This review summarizes key relevant literature regarding the epidemiology, diagnosis, treatment, and preventive measures related to cardiovascular complications in the setting of COVID-19.
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Affiliation(s)
- Marcos I Restrepo
- Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health San Antonio, San Antonio, Texas.,Section of Pulmonary and Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, Texas
| | - Judith Marin-Corral
- Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health San Antonio, San Antonio, Texas.,Critical Care Department, Hospital del Mar-IMIM; Critical Illness Research Group (GREPAC), Barcelona, Spain.,Department of Critical Care, Critical Illness Research Group (GREPAC), Barcelona, Spain
| | - Juan J Rodriguez
- Department of Medicine, Universidad Autónoma de Bucaramanga, Colombia
| | - Valeria Restrepo
- Department of Biology, University of Texas San Antonio - UTSA, San Antonio, Texas
| | - Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Louisville, Kentucky
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15
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Paknahad MH, Yancheshmeh FB, Soleimani A. Cardiovascular complications of COVID-19 vaccines: A review of case-report and case-series studies. Heart Lung 2023; 59:173-180. [PMID: 36842342 PMCID: PMC9905103 DOI: 10.1016/j.hrtlng.2023.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 01/24/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND There are multiple reviews on cardiovascular aspects of COVID-19 disease on cardiovascular system in different population but there is lack of evidence about cardiovascular adverse effects of COVID vaccines. OBJECTIVES The purpose of this study was to compare the cardiac complications of COVID19 vaccines, based on vaccine type (mRNA, vector-based, and inactivated vaccines). METHODS A systematic search was performed covering PubMed for English case-reports and case-series studies, and finally 100 studies were included. RESULTS Myocarditis (with overall rate around 1.62%) was shown to be the most common post-COVID19 immunization cardiac event. More than 90% of post-COVID19 vaccination myocarditis occurred after receiving mRNA vaccines (Moderna & Pfizer-BioNTech), but the report of this event was less in the case of vector-based vaccinations and/or inactivated vaccines. Myocarditis was reported more commonly in men and following the second dose of the immunization. Takotsubo cardiomyopathy (TTC) was reported after mRNA (more commonly) and vector-based vaccinations, with no case report after inactivated vaccines. When mRNA and vector-based vaccinations were used instead of inactivated vaccines, a greater frequency of vaccine-induced thrombotic thrombocytopenia (VITT) and pulmonary emboli (PE) was reported. Myocardial infarction/cardiac arrest was recorded in those beyond the age of 75 years. CONCLUSION The personal and public health benefits of COVID-19 vaccination much outweigh the minor cardiac risks. Reporting bias, regarding more available mRNA vaccines in developed countries, may conflict these results.
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Affiliation(s)
- Mohammad Hossein Paknahad
- Cardiologist, Cardiology Department, Chamran Cardiovascular Medical and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatereh Baharlouei Yancheshmeh
- Cardiologist, Cardiology Department, Chamran Cardiovascular Medical and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azam Soleimani
- Associate Professor of Cardiology, Echocardiologist, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; Echocardiography Department, Chamran Cardiovascular Medical and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
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16
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Acehan S, Satar S, Gulen M, Yucel C, Segmen MS. Angina and Arrhythmia Symptoms Following Multiple Bee Stings: Kounis Syndrome. Wilderness Environ Med 2022; 33:417-421. [PMID: 36109267 DOI: 10.1016/j.wem.2022.06.003] [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: 12/15/2021] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Abstract
Kounis syndrome (KS) is an acute coronary syndrome including coronary spasm, acute myocardial infarction, and stent thrombosis preceded by an anaphylactic, anaphylactoid, allergic, or hypersensitivity injury. In this case presentation, we discussed Type I and Type II KS. Case 1 was a 72-y-old man who presented to the emergency department with allergic symptoms and chest pain that developed after multiple bee stings. Electrocardiography showed ST depression in the lateral leads. Case 2 was a 42-y-old woman who presented to the emergency department with complaints of chest pain, dizziness, and presyncope that developed after multiple bee stings. Mobitz Type II Block with right bundle branch block was observed in 42 beats·min-1 in the electrocardiography. Both patients were first treated for allergic reaction. Although early percutaneous coronary intervention was performed for graft thrombosis in Case 1, a permanent pacemaker was inserted in Case 2. The patients were discharged without any complications. Increasing physician awareness towards the existence of KS can prevent fatal outcomes with early diagnosis and treatment.
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Affiliation(s)
| | | | | | - Ceyhun Yucel
- Department of Cardiology, Adana City Training and Research Hospital, Adana, Turkey
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17
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Rivera JA, Aragon D, Gomez J, Arredondo H, Thomas PM, Dominici P, Akala OO, Menowsky M. Acute Hypersensitivity Reaction After Casirivimab/Imdevimab Infusion in a COVID-19-Positive Young Male: Myopericarditis or Kounis Syndrome? Cureus 2022; 14:e31125. [DOI: 10.7759/cureus.31125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 11/06/2022] Open
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18
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Baqi DH, Kakamad FH, Mahmood ZH, Fattah FH, Ahmed SF, Hassan MN, Hama Amin BJ, Mohammed SH, Mikael TM, Hassan HA, Salh AM. Myocardial infarction following COVID-19 vaccine administration; a systematic review. Heliyon 2022; 8:e11385. [PMID: 36406668 PMCID: PMC9650518 DOI: 10.1016/j.heliyon.2022.e11385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/17/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Covid-19 vaccines have been assessed in randomized trials, which are designed to establish efficacy and safety, but are insufficient in power to detect rare adverse outcomes. Among the adverse cardiac events associated with mRNA COVID-19 vaccines are inflammations (e.g., pericarditis or myocarditis), thrombosis, and ischemia. Objective This systematic review aims to evaluate the reported cases of myocardial infarction (MI) after COVID-19 vaccinations. Method Web of Science, MEDLINE on OVID, PubMed, and Google Scholar were searched for English-language papers published until March 25, 2022. Results This study included 15 papers (10 case reports and 5 case series). In total, 20 individuals were included who had received COVID-19 vaccines and experienced MI. Males (55%) reported more adverse occurrences than females (45%) across the majority of event categories. The mean time from the administration of the vaccine to the onset of symptoms was 2 days (0–10 days). The AstraZeneca vaccine was responsible for more than half of the reported events. In the majority of cases, the event developed after receiving the first dose of vaccination. Conclusion MI related to COVID19 vaccination is a rare, but serious and life-threatening condition. Chest discomfort should be regarded as a warning sign, particularly in people who have been administered a dose of the vaccine within the previous two days.
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Affiliation(s)
- Dana H. Baqi
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Fahmi H. Kakamad
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq
- Kscien Organization, Hamdi Str., Azadi Mall, Sulaimani, Kurdistan, Iraq
- Corresponding author.
| | - Zana H. Mahmood
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
- Molecular Diagnostic Laboratory, Sulaimani Veterinary Directorate, Sulaimani, Kurdistan, Iraq
| | - Fattah H. Fattah
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Shaho F. Ahmed
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
| | - Marwan N. Hassan
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
- Kscien Organization, Hamdi Str., Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Bnar J. Hama Amin
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
| | - Shvan H. Mohammed
- Kscien Organization, Hamdi Str., Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Tomas M. Mikael
- Kscien Organization, Hamdi Str., Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Hunar A. Hassan
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
- Kscien Organization, Hamdi Str., Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Abdulwahid M. Salh
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq
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19
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Katsuda S, Kaku B. Plaque rupture and neovascularisation detected with optical coherence tomography in a case of Kounis syndrome. BMJ Case Rep 2022; 15:e251820. [PMID: 36270738 PMCID: PMC9594514 DOI: 10.1136/bcr-2022-251820] [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] [Indexed: 06/16/2023] Open
Abstract
Kounis syndrome is an allergic acute coronary syndrome (ACS) characterised by coronary artery spasm, plaque erosion/rupture or stent thrombosis caused by mast cell and other interacting cell activation. Although intracoronary imaging modalities can detect those ACS mechanisms, Kounis syndrome due to plaque rupture has rarely been reported using intracoronary imaging. We present the case of a woman in her 70s who developed Kounis syndrome as a result of plaque rupture detected with optical coherence tomography (OCT). She had non-ST-segment elevation ACS as a result of anaphylaxis to cefazolin. Coronary angiography revealed severe stenosis in the left anterior descending artery; angiographically undetectable plaque rupture was detected using OCT. OCT also revealed intraplaque neovascularisation, suggesting that the culprit plaque had been vulnerable. OCT can aid in understanding the underlying mechanisms of Kounis syndrome.
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Affiliation(s)
- Shoji Katsuda
- Department of Cardiology, Toyama Red Cross Hospital, Toyama, Japan
| | - Bunji Kaku
- Department of Cardiology, Toyama Red Cross Hospital, Toyama, Japan
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20
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Mahdiabadi S, Rezaei N. Anaphylaxis and allergic reactions to COVID‐19 vaccines: A narrative review of characteristics and potential obstacles on achieving herd immunity. Health Sci Rep 2022; 5:e787. [PMID: 36032518 PMCID: PMC9401640 DOI: 10.1002/hsr2.787] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Aims Methods Results Conclusion
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Affiliation(s)
- Sara Mahdiabadi
- School of Medicine Tehran University of Medical Sciences Tehran Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Children's Medical Center Tehran Iran
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center Tehran University of Medical Sciences Tehran Iran
| | - Nima Rezaei
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Children's Medical Center Tehran Iran
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center Tehran University of Medical Sciences Tehran Iran
- Department of Immunology, School of Medicine Tehran University of Medical Sciences Tehran Iran
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21
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Coronary Vasospastic Angina: A Review of the Pathogenesis, Diagnosis, and Management. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081124. [PMID: 36013303 PMCID: PMC9409871 DOI: 10.3390/life12081124] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 12/26/2022]
Abstract
Vasospastic angina (VSA) is an under-appreciated cause of chest pain. It is characterised by transient vasoconstriction of the coronary arteries and plays a significant role in the pathogenesis of stable angina and acute coronary syndromes. Complex mechanistic pathways characterised by endothelial dysfunction and smooth muscle hypercontractility lead to a broad spectrum of clinical manifestations ranging from recurrent angina to fatal arrhythmias. Invasive provocation testing using intracoronary acetylcholine or ergonovine is considered the current gold standard for diagnosis, but there is a wide variation in protocols amongst different institutions. Conventional pharmacological therapy relies on calcium channel blockers and nitrates; however, refractory VSA has limited options. This review evaluates the pathophysiology, diagnostic challenges, and management strategies for VSA. We believe global efforts to standardise diagnostic and therapeutic guidelines will improve the outcomes for affected patients.
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22
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Baronti A, Gentile F, Manetti AC, Scatena A, Pellegrini S, Pucci A, Franzini M, Castiglione V, Maiese A, Giannoni A, Pistello M, Emdin M, Aquaro GD, Di Paolo M. Myocardial Infarction Following COVID-19 Vaccine Administration: Post Hoc, Ergo Propter Hoc? Viruses 2022; 14:v14081644. [PMID: 36016266 PMCID: PMC9413746 DOI: 10.3390/v14081644] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 12/13/2022] Open
Abstract
Vaccination against coronavirus disease 2019 (COVID-19) is the safest and most effective strategy for controlling the pandemic. However, some cases of acute cardiac events following vaccine administration have been reported, including myocarditis and myocardial infarction (MI). While post-vaccine myocarditis has been widely discussed, information about post-vaccine MI is scarce and heterogenous, often lacking in histopathological and pathophysiological details. We hereby present five cases (four men, mean age 64 years, range 50–76) of sudden death secondary to MI and tightly temporally related to COVID-19 vaccination. In each case, comprehensive macro- and microscopic pathological analyses were performed, including post-mortem cardiac magnetic resonance, to ascertain the cause of death. To investigate the pathophysiological determinants of MI, toxicological and tryptase analyses were performed, yielding negative results, while the absence of anti-platelet factor 4 antibodies ruled out vaccine-induced thrombotic thrombocytopenia. Finally, genetic testing disclosed that all subjects were carriers of at least one pro-thrombotic mutation. Although the presented cases do not allow us to establish any causative relation, they should foster further research to investigate the possible link between COVID-19 vaccination, pro-thrombotic genotypes, and acute cardiovascular events.
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Affiliation(s)
- Arianna Baronti
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
| | - Francesco Gentile
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (F.G.); (V.C.); (A.G.); (G.D.A.)
| | - Alice Chiara Manetti
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
| | - Andrea Scatena
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
| | - Silvia Pellegrini
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Angela Pucci
- Department of Histopathology, University of Pisa, 56126 Pisa, Italy;
| | - Maria Franzini
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56126 Pisa, Italy;
| | - Vincenzo Castiglione
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (F.G.); (V.C.); (A.G.); (G.D.A.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Aniello Maiese
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
| | - Alberto Giannoni
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (F.G.); (V.C.); (A.G.); (G.D.A.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Mauro Pistello
- Retrovirus Center and Virology Section, Department of Translational Research, University of Pisa, 56126 Pisa, Italy;
| | - Michele Emdin
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (F.G.); (V.C.); (A.G.); (G.D.A.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Correspondence: or
| | | | - Marco Di Paolo
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
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23
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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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24
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Fujita M, Shibasaki S, Nakamura K, Nakauchi M, Tanaka T, Inaba K, Uyama I, Suda K. A Case of Kounis Syndrome That Developed after Gastrectomy for Gastric Cancer. THE JAPANESE JOURNAL OF GASTROENTEROLOGICAL SURGERY 2022; 55:440-448. [DOI: 10.5833/jjgs.2021.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Affiliation(s)
| | | | | | - Masaya Nakauchi
- Advanced Robotic and Endoscopic Surgery, Fujita Health University
| | - Tsuyoshi Tanaka
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University
| | - Kazuki Inaba
- Advanced Robotic and Endoscopic Surgery, Fujita Health University
| | - Ichiro Uyama
- Advanced Robotic and Endoscopic Surgery, Fujita Health University
| | - Koichi Suda
- Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University
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25
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Mishra A, Komut O, Kumar A, Ete T, Megeji RD. Acute Myocardial Infarction After COVID-19 Vaccination: A Case Report. Cureus 2022; 14:e25536. [PMID: 35800833 PMCID: PMC9246448 DOI: 10.7759/cureus.25536] [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] [Accepted: 05/30/2022] [Indexed: 11/05/2022] Open
Abstract
Following the coronavirus disease 2019 (COVID-19) pandemic, nations all over the world started vaccination programs against the SARS-CoV2 virus. With the widespread administration of the vaccine across the globe, various cases were reported with thrombotic events after vaccination. Here, we are presenting a case of acute anterior wall myocardial infarction (AWMI) after ChAdOx1 nCoV- 19 corona virus (recombinant) vaccination. A 68-year-old male who was a known case of hypertension, non-smoker on antihypertensive took COVISHIELD vaccination and presented with acute anterior wall myocardial infarction within 12 hours and was taken up for primary angioplasty. On coronary angiography, mid-left anterior descending artery (LAD) was 99% stenosed. Following angiography percutaneous transluminal coronary angioplasty (PTCA), deployment of a drug eluting stent was done. Post-procedure time was uneventful. He was started on intravenous fluids and amiodarone infusion. The patient recovered and was discharged in stable condition. The leading approach to handling COVID-19 pandemic is mass vaccination. In this case, the MI after vaccination might be coincidental. We want to highlight this case as that the complication can occur during the mass vaccination programs and hence adequate precautionary measures like basic life support, EKG monitoring, and emergency ambulance services should be present in all primary and community health centers (PHC and CHC). This will help in avoiding the COVID vaccination hesitancy among the general public.
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26
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Elheet A, Farrag M, Elkeliei M, Alabdali A. Acute myocardial infarction following COVID-19 vaccination: a cause or a coincidence? CARDIOMETRY 2022. [DOI: 10.18137/cardiometry.2022.22.143146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background. Acute Myocardial Infarction (AMI) is a fatal condition with a subsequent variety of complications. Recently, COVID-19 vaccine has become an essential precaution to avoid infection. However, it is uncommon for AMI to manifest as a result of the COVID-19 vaccination. Methods. Thirty-two years old man, previously healthy, come to the emergency department with a four-hour history of chest discomfort after Covishield (AstraZeneca) vaccination. He was neither hypertensive, diabetic, or smoker and lacked any other typical risk factors for cardiovascular disease. Results. This case describes an adverse response to the COVID-19 vaccination that has the potential to be life-threatening. He had received his first dose of the Covishield vaccination five days prior. Extensive anterior STEMI was diagnosed post-cardiac arrest. He had primary percutaneous coronary intervention (PCI) to recanalize an occluded proximal LAD. Conclusions. Additional screenings for young individuals should be considered before administering the COVID-19 (AstraZeneca) vaccine as a preventive step if reports of significant adverse events in older adults continue.
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27
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Kamarullah W, Firmansyah DK. Recognizing Kounis Syndrome, the Unusual Possible Culprit of Acute Coronary Syndrome: A Rare Case Report. Int J Angiol 2022. [DOI: 10.1055/s-0042-1743564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractKounis syndrome encompasses acute coronary syndrome features associated with severe vasospasm of the coronary artery. It is related to allergic anaphylactic reaction triggered by the release of inflammatory cells and mediators. This entity, however, is often not properly diagnosed. In this report, we aimed to discuss a case of Kounis syndrome mimicking acute coronary syndrome. We presented a 58-year-old man with dyspnea, chest pain, dizziness, and itchiness 30 minutes following sodium diclofenac ingestion. His physical examination was remarkable for shock with hypoxia and features of anaphylactic reaction. An urgent electrocardiogram was obtained, manifesting deep ST-segment depression in anterolateral leads with ST elevation of aVR, which hinted a severe three-vessel disease or left main disease. Allergic acute coronary syndrome was suspected. Thus, the patient was managed with fluid resuscitation, epinephrine, and corticosteroid injection along with acute coronary syndrome treatment algorithm with a favorable clinical response. One-hour serial ECG showed complete resolution of ST depression with aVR normalization. This pointed to possible acute coronary spasm. No further coronary intervention was performed, the patient was discharged after 2 days in good condition and planned for further cardiac evaluation during follow-up. Kounis syndrome is an intriguing process caused by the presence of two disease entities that must be treated simultaneously. The difficulty in treating this condition stems from the fact that treating one of both entities may aggravate the other. Thus, a comprehensive approach and health education are strongly advised to ensure that this condition does not reoccur in the future.
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Affiliation(s)
- William Kamarullah
- Internship Doctor, R. Syamsudin SH Regional Public Hospital, Sukabumi, West Java, Indonesia
| | - Dena Karina Firmansyah
- Department of Cardiology and Vascular Medicine, R. Syamsudin SH Regional Public Hospital, Sukabumi, West Java, Indonesia
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28
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Hana D, Patel K, Roman S, Gattas B, Sofka S. Clinical Cardiovascular Adverse Events Reported Post-COVID-19 Vaccination: Are They a Real Risk? Curr Probl Cardiol 2022; 47:101077. [PMID: 34902392 PMCID: PMC8662957 DOI: 10.1016/j.cpcardiol.2021.101077] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 12/21/2022]
Abstract
Given the urgent need to control the spread of the novel COVID-19 virus, 13 vaccines have been approved for emergency use before completing all 3 phases of the clinical trials. Thereby a careful monitor of the adverse effects postvaccination is essential. We searched through PubMed and other reporting systems like VAERS for the reported cardiovascular adverse events post-COVID-19 vaccination. Through our review, we determined that the incidence of all the reported cardiovascular events is very rare. Additionally, the vaccine was initially given to the elderly and high-risk populations in which cardiovascular events such as myocardial infarction and arrhythmias are already more prevalent, while other cardiovascular events such as myocarditis or vaccine-induced thrombotic thrombocytopenia were more common in younger populations. Moreover, a direct causal relationship, if any, between vaccination and adverse events is yet to be fully elucidated. Thus, at this time point, the benefits of vaccination far outweigh the risk.
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Affiliation(s)
- David Hana
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV.
| | - Kevin Patel
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Sherif Roman
- Department of Medicine, St Joseph's University Medical Center, Paterson, NJ
| | - Boula Gattas
- Department of Medicine, St Mary Medical Center, Langhorne, PA
| | - Sarah Sofka
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
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Different types of Kounis syndrome caused by different episodes of bee sting anaphylaxis: Misfortunes never come singly. J Cardiol Cases 2022; 26:81-84. [DOI: 10.1016/j.jccase.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/20/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022] Open
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Cil M, Leblebisatan G, Leblebisatan S, Barutcu A, Cil MK, Kilinc Y. Deep Vein Thrombosis After a Wild Bee Sting. J Pediatr Hematol Oncol 2022; 44:e241-e242. [PMID: 33512868 DOI: 10.1097/mph.0000000000002072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/14/2020] [Indexed: 11/26/2022]
Abstract
Allergic reactions from insect bites are mostly observed with bee stings. Bee sting reactions can be classified into 3 main headings: local, systemic, and rare reactions. Vascular thrombosis is considered both in rare and systemic reactions. The wild bee venom induces the secretion of many inflammatory mediators, including histamine, phospholipase A1, and thromboxane, leading to vasoconstriction and thrombosis. Inflammatory cytokines also cause endothelial injury and deterioration of the microcirculation. In the literature, rare reactions have been reported including various central and arterial vascular pathologies such as aortic thrombosis, cerebral infarction, and myocardial infarction; however, there is rare publication concerning peripheral deep vein thrombosis (DVT). Although DVT produces good results with effective and rapid treatment, it can be fatal because of causes such as pulmonary embolism in the absence of timely intervention. Herein, for the first time in the literature, we present a pediatric case of peripheral DVT after a wild bee sting.
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Affiliation(s)
| | | | - Serife Leblebisatan
- Department of Radiology, Adana City Training and Research Hospital, Adana, Turkey
| | | | - Merve K Cil
- Pediatric Infectious Disease, Cukurova University Medical Faculty
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Wang C, Deng Z, Song L, Sun W, Fang W, Li Z. Analysis of clinical characteristics of Kounis syndrome induced by contrast media. Am J Emerg Med 2021; 52:203-207. [PMID: 34959022 DOI: 10.1016/j.ajem.2021.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Understanding the relationship between contrast agents and Kounis syndrome (KS) is mainly based on case reports. The purpose of this research is to explore the clinical characteristics of contrast media induced KS. METHODS We searched for contrast-induced KS case reports through Chinese and English databases from 1991 to October 31, 2021. RESULTS A total of 26 patients (19 men and 7 women,) were included, with a median age of 60 years (range 30-83). The contrast agents that cause KS mainly included gadolinium-based contrast agent (7 cases), iodine-containing contrast media (12 cases). KS mainly occurred within 30 min after administration and mainly manifests as chest pain and allergic reactions. Electrocardiogram (ECG) mainly showed ST elevation. Echocardiography mainly revealed normal. Coronary angiography showed normal, coronary vasospasm, stent thrombosis, occlusion and stenosis. After treatment with steroids, antihistamines and anti-ischemic therapy, 24 patients recovered completely and 2 patients died. CONCLUSIONS KS is a rare adverse reaction of contrast media. Radiologists should recognize this rare but serious disease to ensure rapid diagnosis and proper management.
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Affiliation(s)
- Chunjiang Wang
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhenzhen Deng
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Liying Song
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Wei Sun
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Weijin Fang
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zuojun Li
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China.
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Shiravi AA, Ardekani A, Sheikhbahaei E, Heshmat-Ghahdarijani K. Cardiovascular Complications of SARS-CoV-2 Vaccines: An Overview. Cardiol Ther 2021; 11:13-21. [PMID: 34845662 PMCID: PMC8629102 DOI: 10.1007/s40119-021-00248-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Indexed: 12/19/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of the deadly disease known as coronavirus disease 2019 (COVID-19) that has reached pandemic proportions. Currently, there is no definitive treatment for COVID-19, although many vaccines have been developed. The World Health Organization has approved the safety and efficacy of the AstraZeneca/Oxford, Johnson and Johnson/Janssen (JnJ), Moderna, Pfizer/BioNTech, Sinopharm, and Sinovac vaccines so far. The approved formulations of AstraZeneca, JnJ, and Gam-COVID-vac (Sputnik V) contain DNA delivered within non-replicating recombinant adenovirus vector-based systems, while the Pfizer and Moderna vaccines utilize mRNA technology and lipid nanoparticle delivery systems. All of these vaccines encode production of the SARS-CoV-2 spike (S) protein, ultimately triggering immunity in the human body. COVID-19 causes several cardiovascular complications, such as arrhythmias, myocarditis, pericarditis, and venous thromboembolism. SARS-CoV-2 vaccines have been associated with rare, but sometimes fatal, cardiovascular side effects, which are the topics of this review. SARS-CoV-2 vaccines in general may cause thromboembolic events, such as cerebral vein thrombosis, and mRNA-based vaccines in particular may cause myocarditis/pericarditis, with the latter more likely to occur in younger adults after the second vaccination dose. Nevertheless, the advantages of these vaccines for ending the pandemic and/or decreasing the mortality rate outweigh any risk for the rare cardiovascular complications.
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Affiliation(s)
- Amir Abbas Shiravi
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Esfahān, Iran
| | - Ali Ardekani
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Erfan Sheikhbahaei
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Esfahān, Iran.,Cardiovascular Research Institute, Isfahan Cardiovascular Research Center, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Blvd., Azadi Sq., Esfahān, Iran
| | - Kiyan Heshmat-Ghahdarijani
- Cardiovascular Research Institute, Isfahan Cardiovascular Research Center, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Blvd., Azadi Sq., Esfahān, Iran.
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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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Chioncel V, Andrei CL, Brezeanu R, Sinescu C, Avram A, Tatu AL. Some Perspectives on Hypersensitivity to Coronary Stents. Int J Gen Med 2021; 14:4327-4336. [PMID: 34408475 PMCID: PMC8364397 DOI: 10.2147/ijgm.s326679] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022] Open
Abstract
The development of coronary stents has represented a revolution in the treatment of coronary heart disease. Beyond their many advantages, stents also have their limitations and complications. Allergic reactions to coronary stents are more common than acknowledged. These stented patients are exposed to foreign substances inserted in direct contact with the coronary intima. Hypersensitivity to stent components and drugs prescribed after stent insertion together with any environmental exposure seem to contribute to these adverse reactions. Patients can present to the hospital with a wide range of symptoms and multiple complications, the most important ones being instent restenosis and stent thrombosis. Although not very common (and not always easy to identify), allergic reactions after coronary or peripheral stents should be taken into account. Careful selection of patients (for elective stent implantation) depending on the propensity to allergies, although hard to achieve, represents a key factor in reducing the number of these complications.
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Affiliation(s)
- Valentin Chioncel
- Department of Cardio-Thoracic Pathology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, 050474, Romania
| | - Catalina Liliana Andrei
- Department of Cardio-Thoracic Pathology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, 050474, Romania
| | - Radu Brezeanu
- Department of Cardio-Thoracic Pathology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, 050474, Romania
| | - Crina Sinescu
- Department of Cardio-Thoracic Pathology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, 050474, Romania
| | - Anamaria Avram
- Department of Cardio-Thoracic Pathology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, 050474, Romania
| | - Alin Laurentiu Tatu
- Medical and Pharmaceutical Research Unit/Competitive, Interdisciplinary Research Integrated Platform "Dunărea de Jos", ReForm-UDJG, Research Centre in the Field of Medical and Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, Clinical Medical Department, "Dunărea de Jos" University of Galati, Galati, 800010, Romania
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Haddad A, Smith T, Bole A, Shah M, Chakravarthy M. Type I Kounis syndrome variant: A case report and literature review. Avicenna J Med 2021; 8:37-39. [PMID: 29404272 PMCID: PMC5782419 DOI: 10.4103/ajm.ajm_114_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Kounis syndrome defined as the occurrence of acute coronary syndrome in the setting of allergic reaction due to mast cells activation and inflammatory mediators release that induces coronary vasospasm, plaque erosion, or even stent thrombosis. A 25-year-old postpartum female with asthma and recurrent episodes of chest pain was admitted with ST-segment elevation myocardial infarction in the setting of coronary artery spasms. The patient was started on calcium channel blockers and nitrite-based medication with no improvement. She was noted to have eosinophilia and initiation of corticosteroid-based regimen lead to resolution of chest pain episodes and normalization of eosinophilia. Kounis syndrome should be considered in young patients with chest pain. Coronary vasodilators are considered as the first-line of treatment. The use of corticosteroids has been described in the literature in severe or refractory cases.
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Affiliation(s)
- Abdullah Haddad
- Department of Internal Medicine, Saint Clair Memorial Hospital, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Triston Smith
- Department of Internal Medicine, Saint Clair Memorial Hospital, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Aneel Bole
- Department of Internal Medicine, Saint Clair Memorial Hospital, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Moneal Shah
- Department of Internal Medicine, Saint Clair Memorial Hospital, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Mithun Chakravarthy
- Department of Internal Medicine, Saint Clair Memorial Hospital, Allegheny General Hospital, Pittsburgh, PA, USA
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COVID-19 Disease, Women's Predominant Non-Heparin Vaccine-Induced Thrombotic Thrombocytopenia and Kounis Syndrome: A Passepartout Cytokine Storm Interplay. Biomedicines 2021; 9:biomedicines9080959. [PMID: 34440163 PMCID: PMC8391920 DOI: 10.3390/biomedicines9080959] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) constitute one of the deadliest pandemics in modern history demonstrating cardiovascular, gastrointestinal, hematologic, mucocutaneous, respiratory, neurological, renal and testicular manifestations and further complications. COVID-19-induced excessive immune response accompanied with uncontrolled release of cytokines culminating in cytokine storm seem to be the common pathogenetic mechanism of these complications. The aim of this narrative review is to elucidate the relation between anaphylaxis associated with profound hypotension or hypoxemia with pro-inflammatory cytokine release. COVID-19 relation with Kounis syndrome and post-COVID-19 vaccination correlation with heparin-induced thrombocytopenia with thrombosis (HITT), especially serious cerebral venous sinus thrombosis, were also reviewed. Methods: A current literature search in PubMed, Embase and Google databases was performed to reveal the pathophysiology, prevalence, clinical manifestation, correlation and treatment of COVID-19, anaphylaxis with profuse hypotension, Kounis acute coronary syndrome and thrombotic events post vaccination. Results: The same key immunological pathophysiology mechanisms and cells seem to underlie COVID-19 cardiovascular complications and the anaphylaxis-associated Kounis syndrome. The myocardial injury in patients with COVID-19 has been attributed to coronary spasm, plaque rupture and microthrombi formation, hypoxic injury or cytokine storm disposing the same pathophysiology with the three clinical variants of Kounis syndrome. COVID-19-interrelated vaccine excipients as polysorbate, polyethelene glycol (PEG) and trometamol constitute potential allergenic substances. Conclusion: Better acknowledgement of the pathophysiological mechanisms, clinical similarities, multiorgan complications of COVID-19 or other viral infections as dengue and human immunodeficiency viruses along with the action of inflammatory cells inducing the Kounis syndrome could identify better immunological approaches for prevention, treatment of the COVID-19 pandemic as well as post-COVID-19 vaccine adverse reactions.
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Ben-Yakov M, James V, Slomovic B. A Young Patient With Hives and Chest Pain. JAMA Cardiol 2021; 6:847-848. [PMID: 33881455 DOI: 10.1001/jamacardio.2021.0749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Maxim Ben-Yakov
- Division of Emergency Medicine, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
| | - Vigil James
- Children's Emergency Department, KK Women's and Children's Hospital PTE Ltd, Singapore
| | - Brant Slomovic
- Division of Emergency Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,University Health Network, University of Toronto, Toronto, Ontario, Canada
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Chatterjee S, Ojha UK, Vardhan B, Tiwari A. Myocardial infarction after COVID-19 vaccination-casual or causal? Diabetes Metab Syndr 2021; 15:1055-1056. [PMID: 33888439 PMCID: PMC8045430 DOI: 10.1016/j.dsx.2021.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Subhankar Chatterjee
- Department of General Medicine, Patliputra Medical College & Hospital, Dhanbad, Jharkhand, India.
| | - Umesh Kumar Ojha
- Department of General Medicine, Patliputra Medical College & Hospital, Dhanbad, Jharkhand, India.
| | - Bhagya Vardhan
- Department of General Medicine, Patliputra Medical College & Hospital, Dhanbad, Jharkhand, India.
| | - Amit Tiwari
- Surveillance Medical Officer, World Health Organization, Dhanbad, Jharkhand, India.
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Navaradnam P, Suganthan N, Kumanan T, Sujanitha V, Mayorathan U. Kounis Syndrome and Multiorgan Failure Following Multiple Wasp Stings. Cureus 2021; 13:e14606. [PMID: 34040907 PMCID: PMC8139607 DOI: 10.7759/cureus.14606] [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: 11/10/2022] Open
Abstract
Wasp and bee stings are common in Sri Lanka, and systemic envenomation causes a spectrum of clinical manifestations that includes simple local allergic reaction to life-threatening multiple organ injury or failure. However, wasp toxin-induced acute myocardial infarction is very rare in the literature. Here, we describe a pregnant lady with mass wasp stings who developed toxin-induced acute myocardial infarction with multiorgan injury. The treating physician should anticipate the complications of massive envenomation following multiple wasp stings.
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An Autopsy Case of Spontaneous Coronary Artery Dissection With Eosinophilic Coronary Periarteritis and Degeneration of Medial Smooth Muscles. Am J Forensic Med Pathol 2021; 42:387-391. [PMID: 33853104 DOI: 10.1097/paf.0000000000000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT A 45-year-old woman with no known medical history died suddenly shortly after complaining of anterior chest discomfort. The autopsy revealed a dissection at the anterior descending branch of the left coronary artery, and eosinophilic adventitial inflammation was observed both in the right coronary artery and in the vicinity of the dissection. Furthermore, there was degeneration of the tunica media in the right coronary artery, and this was thought to be a predissection lesion. In the degenerated area of the tunica media, probable apoptosis of smooth muscle cells was noted, suggesting that the degeneration was not due only to the effect of eosinophilic lytic enzymes. These findings also indicated that eosinophilic infiltration preceded the dissection. Eosinophilic infiltration around the coronary arteries is occasionally observed in cases of sudden death, but although it might be associated with the death, the pathological mechanism is yet to be elucidated. Eosinophilic periarteritis has also been observed around the site of spontaneous coronary artery dissection, although a causal relationship is unproven. The histopathology of this case indicated that the eosinophilic infiltration preceded the dissection. Detailed pathological findings are presented, together with a review of the literature.
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Acute Coronary Syndrome and Arrhytmia Induced by SARS-CoV-2 Infection in a Patient with Non-Significant LAD Lesion. A Case Report. JOURNAL OF INTERDISCIPLINARY MEDICINE 2021. [DOI: 10.2478/jim-2021-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: Coronavirus disease 2019 (COVID-19) has emerged as a pandemic and public health crisis of an unprecedent effect. Clinical studies reported an association between COVID-19 and cardiovascular disease, whereas COVID-19 itself can induce myocardial injury, arrhythmia, acute coronary syndrome, and venous thromboembolism.
Case summary: A patient diagnosed via screening coronary computed tomography angiography with non-obstructive coronary artery disease was hospitalized with non-ST elevation myocardial infarction and atrial flutter during a severe respiratory infection episode with SARS-CoV-2. After recovery from the infectious episode, fractional flow reserve-guided elective percutaneous coronary intervention with drug-eluting stent was performed.
Conclusions: COVID-19 intercurrence in a cardiovascular patient with nonobstructive coronary artery disease triggered coronary plaque vulnerabilization with subsequent development of an acute coronary syndrome. SARS-CoV-2 proved to be involved via direct viral tissue involvement and concomitant mechanisms derived from systemic illness in the development of a severe supraventricular arrhythmic event.
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Allergic Reactions to Current Available COVID-19 Vaccinations: Pathophysiology, Causality, and Therapeutic Considerations. Vaccines (Basel) 2021; 9:vaccines9030221. [PMID: 33807579 PMCID: PMC7999280 DOI: 10.3390/vaccines9030221] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 12/18/2022] Open
Abstract
Vaccines constitute the most effective medications in public health as they control and prevent the spread of infectious diseases and reduce mortality. Similar to other medications, allergic reactions can occur during vaccination. While most reactions are neither frequent nor serious, anaphylactic reactions are potentially life-threatening allergic reactions that are encountered rarely, but can cause serious complications. The allergic responses caused by vaccines can stem from activation of mast cells via Fcε receptor-1 type I reaction, mediated by the interaction between immunoglobulin E (IgE) antibodies against a particular vaccine, and occur within minutes or up to four hours. The type IV allergic reactions initiate 48 h after vaccination and demonstrate their peak between 72 and 96 h. Non-IgE-mediated mast cell degranulation via activation of the complement system and via activation of the Mas-related G protein-coupled receptor X2 can also induce allergic reactions. Reactions are more often caused by inert substances, called excipients, which are added to vaccines to improve stability and absorption, increase solubility, influence palatability, or create a distinctive appearance, and not by the active vaccine itself. Polyethylene glycol, also known as macrogol, in the currently available Pfizer-BioNTech and Moderna COVID-19 mRNA vaccines, and polysorbate 80, also known as Tween 80, in AstraZeneca and Johnson & Johnson COVID-19 vaccines, are excipients mostly incriminated for allergic reactions. This review will summarize the current state of knowledge of immediate and delayed allergic reactions in the currently available vaccines against COVID-19, together with the general and specific therapeutic considerations. These considerations include: The incidence of allergic reactions and deaths under investigation with the available vaccines, application of vaccination in patients with mast cell disease, patients who developed an allergy during the first dose, vasovagal symptoms masquerading as allergic reactions, the COVID-19 vaccination in pregnancy, deaths associated with COVID-19 vaccination, and questions arising in managing of this current ordeal. Careful vaccine-safety surveillance over time, in conjunction with the elucidation of mechanisms of adverse events across different COVID-19 vaccine platforms, will contribute to the development of a safe vaccine strategy. Allergists’ expertise in proper diagnosis and treatment of allergic reactions is vital for the screening of high-risk individuals.
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Elements of Immunoglobulin E Network Associate with Aortic valve Area in Patients with Acquired Aortic Stenosis. Biomedicines 2020; 9:biomedicines9010023. [PMID: 33396395 PMCID: PMC7824289 DOI: 10.3390/biomedicines9010023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/23/2020] [Accepted: 12/26/2020] [Indexed: 12/16/2022] Open
Abstract
Allergic mechanisms are likely involved in atherosclerosis and its clinical presentations, such as coronary artery disease (CAD). It has been previously reported that CAD severity associates with serum levels of immunoglobulin E (IgE), the molecule that, along with its high-affinity receptor (FcԑRI), plays a central role in allergic reactions. Considering multiple pathophysiological similarities between atherosclerosis and acquired aortic (valve) stenosis (AS), we speculated that allergic pathways could also contribute to the AS mechanisms and grading. To validate this hypothesis, we first checked whether total serum IgE levels associate with echocardiographic markers of AS severity. Having found a positive correlation between serum IgE and aortic valve area (AVA), we further speculated that also total IgE-determining genetic polymorphisms in FCER1A, a locus encoding an allergen-biding FcԑRI subunit, are related to acquired AS severity. Indeed, the major allele of rs2251746 polymorphism, known to associate with higher IgE levels, turned out to correlate with larger AVA, a marker of less severe AS. Our findings surprisingly suggest a protective role of IgE pathways against AS progression. IgE-mediated protective mechanisms in AS require further investigations.
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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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Giovannini M, Alletto A, Koniari I, Mori F, Favilli S, Sarti L, Barni S, Liccioli G, Lodi L, Indolfi G, Novembre E, Kounis NG. Kounis Syndrome: a pediatric perspective. Minerva Pediatr 2020; 72:383-392. [DOI: 10.23736/s0026-4946.20.06007-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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What is causing this patient's chest pain? JAAPA 2020; 33:55-57. [DOI: 10.1097/01.jaa.0000721708.44548.1b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Peláez-Pérez JM, Sánchez Casado M, Álvarez-Twose I, Kounis NG. Amoxicillin-clavulanic acid-induced type II Kounis syndrome during general anaesthesia complicated with hypoxic-ischaemic encephalopathy. ACTA ACUST UNITED AC 2020; 68:161-164. [PMID: 33172656 DOI: 10.1016/j.redar.2019.06.009] [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: 01/23/2019] [Accepted: 06/04/2019] [Indexed: 10/23/2022]
Abstract
Anaphylaxis is a severe acute multisystem syndrome involving massive mediator release from mast cells and basophils. Although the entire arterial system can be affected, when coronary arteries are the main targets, Kounis syndrome needs to be considered. Cerebral artery involvement has also been suggested in rarer MC-mediator release episodes; so-called 'Kounis-like' syndrome. Cerebral ischaemic lesions can then result from low blood pressure or direct proinflammatory and/or vasoconstrictive mediator action in the cerebral arterial system. Diagnosis can be difficult in anaesthetised patients, as low blood pressure can have multiple causes. Treatment is also challenging, as administering adrenaline can worsen ischaemia. We report the first case of amoxicillin-clavulanic acid-induced type II Kounis syndrome under general anaesthesia, complicated with severe, irreversible and subsequently fatal encephalopathy of ischaemic origin. This case can contribute to awareness of less common Kounis syndrome manifestations, including severe cerebral involvement, or other anaphylactic reactions with atypical presentations.
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Affiliation(s)
- J M Peláez-Pérez
- Departamento de Anestesiología, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España.
| | - M Sánchez Casado
- Servicio de Medicina Intensiva, Complejo Hospitalario de Toledo, Toledo, España
| | - I Álvarez-Twose
- Servicio de Medicina Intensiva, Complejo Hospitalario de Toledo, Toledo, España
| | - N G Kounis
- Departamento de Cardiología, University of Patras Medical School, Patras, Achia, Grecia
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Mori F, Barni S, Saretta F, Castagnoli R, Arasi S, Mastrorilli C, Pecoraro L, Liotti L, Caminiti L, Giovannini M, Novembre E. Epidemiology of rare allergic diseases in children. Pediatr Allergy Immunol 2020; 31 Suppl 26:39-42. [PMID: 33236442 DOI: 10.1111/pai.13359] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 02/02/2023]
Abstract
Allergic diseases have different frequencies. In particular, allergic rhinitis and asthma have high frequencies of about 20% and 10%, respectively. Other allergic diseases have lower frequencies; for example, food allergy has a frequency of 1%-4%. There are also rare allergic diseases, with a prevalence of 5 cases per 10 000 people in the general population, and they are included in Orphanet. However, other extremely rare allergic diseases still need to be properly known in order to be possibly recognized as rare diseases and cataloged in Orphanet.
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Affiliation(s)
- Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Simona Barni
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Francesca Saretta
- Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Riccardo Castagnoli
- Department of Pediatrics, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Stefania Arasi
- Predictive and Preventive Medicine Research Unit, Multifactorial and Systemic Diseases Research Area, Pediatric Allergy Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Carla Mastrorilli
- Pediatric Unit and Emergency, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, Bari, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Luca Pecoraro
- Pediatric Unit, ASST Mantua, Mantua, Italy.,Department of Medicine, University of Verona, Policlinico GB Rossi, Verona, Italy
| | - Lucia Liotti
- Pediatric Unit, Senigallia Hospital, Senigallia, Italy
| | - Lucia Caminiti
- Department of Human Pathology in Adult and Development Age "Gaetano Barresi", Allergy Unit, Department of Pediatrics, AOU Policlinico Gaetano Martino, Messina, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Elio Novembre
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
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Saba L, Gerosa C, Wintermark M, Hedin U, Fanni D, Suri JS, Balestrieri A, Faa G. Can COVID19 trigger the plaque vulnerability-a Kounis syndrome warning for "asymptomatic subjects". Cardiovasc Diagn Ther 2020; 10:1352-1355. [PMID: 33224760 PMCID: PMC7666923 DOI: 10.21037/cdt-20-561] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/29/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy
| | - Clara Gerosa
- Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy
| | - Max Wintermark
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
| | - Ulf Hedin
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Daniela Fanni
- Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy
| | - Jasjit S. Suri
- Stroke Monitoring and Diagnosis Division, AtheroPoint, Roseville, CA, USA
| | - Antonella Balestrieri
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy
| | - Gavino Faa
- Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy
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Frountzas M, Karathanasis P, Vrakopoulou GZ, Theodoropoulos C, Zografos CG, Schizas D, Zografos GC, Michalopoulos NV. Kounis syndrome after patent blue dye injection for sentinel lymph node biopsy. Breast Cancer 2020; 27:1191-1197. [PMID: 32601801 DOI: 10.1007/s12282-020-01129-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/22/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Kounis syndrome (KS) has been described as an acute coronary syndrome (ACS) associated with an anaphylactic reaction. Several triggers have been identified and the diagnostic and treatment process can be challenging. CASE A 58-year-old, female patient diagnosed with breast cancer and no history of allergies had subcutaneous injection of patent blue V dye for sentinel lymph node biopsy (SLNB). Intraoperatively, she developed anaphylactic shock and was transferred to the intensive care unit (ICU). A few hours later, electrocardiographic alterations and elevation of blood troponin were observed. Emergency coronary angiography revealed no occlusive lesions in coronary vessels. Further investigation in the allergy department set the diagnosis of KS. CONCLUSION There are just ten cases of perioperative KS in the literature so far and here we present the first one triggered by patent blue V dye for sentinel node biopsy.
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Affiliation(s)
- Maximos Frountzas
- 1st Department of Propaedeutic Surgery, Medical School, "Hippocratio" General Hospital, University of Athens, 114 Vas. Sophias Av, 11527, Athens, Greece.
| | - Panagiotis Karathanasis
- 1st Department of Propaedeutic Surgery, Medical School, "Hippocratio" General Hospital, University of Athens, 114 Vas. Sophias Av, 11527, Athens, Greece
| | - Gavriella Zoi Vrakopoulou
- 1st Department of Propaedeutic Surgery, Medical School, "Hippocratio" General Hospital, University of Athens, 114 Vas. Sophias Av, 11527, Athens, Greece
| | - Charalampos Theodoropoulos
- 1st Department of Propaedeutic Surgery, Medical School, "Hippocratio" General Hospital, University of Athens, 114 Vas. Sophias Av, 11527, Athens, Greece
| | - Constantinos G Zografos
- 1st Department of Surgery, Medical School, University of Athens, "Laiko" General Hospital, 17 Agiou Thoma St, 11527, Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, Medical School, University of Athens, "Laiko" General Hospital, 17 Agiou Thoma St, 11527, Athens, Greece
| | - George C Zografos
- 1st Department of Propaedeutic Surgery, Medical School, "Hippocratio" General Hospital, University of Athens, 114 Vas. Sophias Av, 11527, Athens, Greece
| | - Nikolaos V Michalopoulos
- 1st Department of Propaedeutic Surgery, Medical School, "Hippocratio" General Hospital, University of Athens, 114 Vas. Sophias Av, 11527, Athens, Greece
- 4th Dept. of Surgery, Medical School, "Attikon" University Hospital, University of Athens, 1 Rimini St, 12462, Chaidari, Greece
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