Kounis syndrome: from an unexpected case in the Emergency Room to a review of the literature

Case Report: A case of Kounis syndrome induced by iodine contrast agent during coronary angiography

Kounis Syndrome (KS), a seldom-seen adverse reaction to iodine contrast agents, has an incidence that remains unclear. At present, there are no unified guidelines for managing KS either nationally or internationally. Ioversol, a new triiodinated hypotonic nonionic contrast agent, is commonly used in cardiovascular Computed Tomography (CT) and vascular imaging for diagnostic purposes. Its principal adverse reactions encompass fever, dermatological responses, convulsions, respiratory distress, hypersensitivity reactions including KS, and acute renal injury. This paper documents a case of KS induced by an iodine contrast agent during coronary angiography and, at the same time, searches for related literature and carries out a summary analysis in an attempt to provide a dependable reference for clinicians to make accurate diagnoses and treatments.

Cellular and Molecular Mechanisms of Mast Cells in Atherosclerotic Plaque Progression and Destabilization

Mast cells (MCs) are commonly recognized for their crucial involvement in the pathogenesis of allergic diseases, but over time, it has come to light that they also play a role in the pathophysiology of non-allergic disorders including atherosclerosis. The involvement of MCs in the pathology of atherosclerosis is supported by their accumulation in atherosclerotic plaques upon their progression and the association of intraplaque MC numbers with acute cardiovascular events. MCs that accumulate within the atherosclerotic plaque release a cocktail of mediators through which they contribute to neovascularization, plaque progression, instability, erosion, rupture, and thrombosis. At a molecular level, MC-released proteases, especially cathepsin G, degrade low-density lipoproteins (LDL) and mediate LDL fusion and binding of LDL to proteoglycans (PGs). Through a complicated network of chemokines including CXCL1, MCs promote the recruitment of among others CXCR2+ neutrophils, therefore, aggravating the inflammation of the plaque environment. Additionally, MCs produce extracellular traps which worsen inflammation and contribute to atherothrombosis. Altogether, evidence suggests that MCs actively, via several underlying mechanisms, contribute to atherosclerotic plaque destabilization and acute cardiovascular syndromes, thus, making the study of interventions to modulate MC activation an interesting target for cardiovascular medicine.

Scorpion Sting: A Hurt to the Heart Reported in a Tertiary Care Hospital in Central Rural India

Scorpion stings are painful but harmless and are rarely life-threatening. There is emerging evidence of the association of electrocardiographic (ECG) changes in patients following scorpion stings. We report a case of scorpion sting in a patient in central rural India and provide a review of similar published cases. A 55-year-old previously healthy female was hospitalized in the department of medicine at our institute within two hours of a scorpion sting. She presented with severe pain at the site of the sting and profuse sweating. Her routine investigations (complete blood count renal function test, liver function tests, and arterial blood gas analysis) results were normal. Her electrocardiogram revealed acute myocardial infarction, and serial ECG showed ST and T-wave changes. On laboratory investigation, it was found that her troponin-T was positive and creatinine phosphokinase levels were raised. There was apical wall hypokinesia on transthoracic echocardiography on Day 1 and Day 2. The patient recovered completely and was discharged within five days of hospitalization once her symptoms improved. This case highlights the severe presentation of scorpion stings in otherwise healthy females. The chances of improved clinical symptoms are more if prazosin (125-250 ug) is administered early after scorpion-stung patients experience cardiac abnormalities. This treatment can dramatically alter scorpion envenomation's morbidity and mortality depending on the duration after which it is administered. This case raised our interest due to cardiovascular manifestations in the patient and the early treatment with prazosin for the scorpion sting. Hence, this case was reported for the purpose of creating awareness among physicians and protecting the more vulnerable population.