An unusual case of concurrent Kounis syndrome and prolonged QT in a young patient

2021 ◽  
pp. 1-3
Author(s):  
Emrah Erdogan ◽  
Murat Cap ◽  
Gorkem Kus ◽  
Cem Gokhan ◽  
Yakup Kilic
Keyword(s):  
Acute Coronary Syndrome ◽  
Young Patient ◽  
Unusual Case ◽  
Allergic Reactions ◽  
Kounis Syndrome ◽  
Unique Case ◽  
Coronary Syndrome ◽  
Life Threatening ◽  
Anaphylactoid Reactions ◽  
Prolonged Qt

Abstract Allergic reactions related to drug use is a common entity presenting often from minor urticaria to life-threatening anaphylactoid reactions. A common but easily overlooked diagnosis, Kounis syndrome, is an established hypersensitivity coronary disorder induced by drugs, foods, environmental factors, and coronary stents that can present in the same way as non-allergy-induced acute coronary syndrome. Here within, we present a unique case of dual presentation of Kounis syndrome and prolonged QTc in a young patient after a single dose of Domperidone and Lansoprazole.

scholarly journals Patient with Acute Coronary Syndrome in the Setting of an Extremely Rare form of Complex Congenital Anomalous Coronaries

Aorta ◽  
2021 ◽  
Author(s):  
Mahmoud Abdelnabi ◽  
Fady Gerges ◽  
Yehia Saleh ◽  
Eman Elsharkawy ◽  
Mohamed Sanhoury ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Young Patient ◽  
Right Coronary Artery ◽  
Unusual Case ◽  
Single Coronary Artery ◽  
Sinus Of Valsalva ◽  
Rare Form ◽  
Coronary Syndrome ◽  
The Right

AbstractA single coronary artery is an exceedingly rare anomaly. Hereby, we present an unusual case of a young patient with an acute coronary syndrome who was found to have a single coronary artery originating from a single ostium in the right sinus of Valsalva with dual left anterior descending (LAD) arteries arising from the right coronary artery with two different anatomical courses, and additionally one of those LADs running a malignant intra-arterial course.

scholarly journals Kounis syndrome after almonds ingestion: From the diagnostic approach to new therapeutic options

2021 ◽  
Vol 17 (3) ◽  
Author(s):  
Giorgio Fiore ◽  
Carlo Gaspardone ◽  
Silvana Di Maio ◽  
Michele Oppizzi ◽  
Alberto Margonato
Keyword(s):  
Acute Coronary Syndrome ◽  
Emergency Physician ◽  
Acute Coronary Syndromes ◽  
Correct Diagnosis ◽  
Kounis Syndrome ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
Anaphylactoid Reactions ◽  
Patient Prognosis ◽  
Diagnostic Work

Acute coronary syndromes can develop with an unusual and challenging presentation. Kounis syndrome is a mostly overlooked Acute Coronary Syndrome (ACS) in the setting of anaphylactic or anaphylactoid reactions in response to an allergic insult that can lead to severe complications including cardiac arrest. A 52-yearold- man presented to the emergency department of our hospital because of acute transient loss of consciousness that developed some minutes after almonds ingestion. The complex diagnostic workup led to the diagnosis of vasospastic Kounis syndrome, an infrequent type of acute coronary syndrome, mostly overlooked, with challenging diagnostic and therapeutic features. Peculiarities on clinical presentation, the approach adopted by the emergency physician and the consultant cardiologist to achieve the correct diagnosis and our proposed management with a brief revision of the literature will be reported. Unusual clinical presentations of acute coronary syndromes represent part of the pitfalls that an emergency physician can face during the everyday practice. Prompt identification of these conditions is always struggling but of crucial importance to improve patient prognosis with a correct diagnostic work-up and therapeutic management.

scholarly journals Zespół Kounisa – interdyscyplinarny problem na styku alergologii i kardiologii y

Alergoprofil ◽  
2021 ◽  
Author(s):  
Magdalena Feusette ◽  
Katarzyna Kapeluszna ◽  
Łukasz Moos ◽  
Piotr Feusette ◽  
Jerzy Sacha ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Allergic Reaction ◽  
Kounis Syndrome ◽  
Coronary Syndrome ◽  
Disease States ◽  
Life Threatening ◽  
History Of ◽  
Systemic Hypersensitivity ◽  
Coronary Syndromes

Life-threatening anaphylaxis is a systemic hypersensitivity reaction that may be allergic or non-allergic. Kounis syndrome is an acute coronary syndrome caused by an allergic reaction. Food, environmental factors, drugs, radiological contrast agents and some disease states are among the etiological factors that trigger an allergic reaction. Kounis syndrome is a relatively rarely recognized cause of myocardial infarction, which is most likely due to its underdiagnosis. The presented case concerns a patient with a history of ischemic heart disease after coronary angioplasty. Until the insect stings, the course of the angina was stable. The course of the allergic reaction was turbulent and met the criteria for anaphylactic shock. Subsequently, the patient developed unstable angina. The clinical picture and additional tests allowed to diagnose a myocardial infarction in the patient. The coincidence of myocardial infarction with a history of an insect sting allows for the recognition of an allergic reaction as a trigger for acute coronary syndrome. The described case highlights the need for a multidisciplinary approach to the patient and regular supervision during the use of specific immunotherapy in the course of allergy to Hymenoptera venom, as well as the inclusion of Kounis syndrome in the differential diagnosis of acute coronary syndromes.

Atypical presentation of acute coronary syndrome in young patient

2014 ◽  
Vol 99 (792) ◽  
pp. 109-110
Author(s):  
María Sierra-Girón-Prieto ◽  
Gema García-Prieto ◽  
Margarita Martínez-Zaldivar-Moreno
Keyword(s):  
Acute Coronary Syndrome ◽  
Young Patient ◽  
Atypical Presentation ◽  
Coronary Syndrome

scholarly journals Dissecting the Diagnosis – An Unusual Case of Pericarditis

2017 ◽  
Vol 16 (4) ◽  
pp. 200-203
Author(s):  
Louise Mundy ◽  
◽  
Purav Desai ◽  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Unusual Case ◽  
Correct Diagnosis ◽  
Timely Manner ◽  
Medical Unit ◽  
Coronary Syndrome ◽  
Acute Medical Unit

Chest pain is an extremely common presenting complaint on the acute medical unit. It is important to distinguish between patients who have serious pathology and those without. Often, the focus is on ruling out an acute coronary syndrome and inadequate consideration is given to other possible causes. This case highlights the importance of performing relevant investigations in a timely manner, in order to ensure that a correct diagnosis is made.

scholarly journals KOUNIS SYNDROME - ALLERGIC MYOCARDIAL INFARCTION. A CASE REPORT

2019 ◽  
Vol 72 (1) ◽  
pp. 137-141
Author(s):  
Olga Wajtryt ◽  
Tadeusz M Zielonka ◽  
Aleksandra Kaszyńska ◽  
Andrzej Falkowski ◽  
Katarzyna Życińska
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Allergic Reaction ◽  
Anaphylactic Shock ◽  
Coronary Artery Spasm ◽  
Kounis Syndrome ◽  
Permanent Damage ◽  
Coronary Syndrome

Kounis syndrome or allergic myocardial infarction is an acute coronary syndrome in the course of an allergic reaction. In allergic patients in response to a specific condition - nourishment, inhalation, environmental substances, drug or insect bite there is an allergic reaction involving many different cells and mediators that can cause coronary artery spasm or initiate the process of rupture and activation of atherosclerotic plaque resulting in acute coronary syndrome. The paper describes a case of a young man with allergy to pollen and confirmed sensitization to nuts, who developed a full-blown anaphylactic shock after eating the nut mix and experienced a rapidly passing acute coronary syndrome with troponin up to 4.7 μg/L. An increased concentration of tryptase (15 μg/L), total IgE (> 3,000 IU/mL) and specific anti-nut IgE (55.1 kUA/L) were found. Based on the course of the disease and the results of allergic and cardiac tests, allergic type 1 myocardial infarction, i.e. caused by coronary artery spasm, was diagnosed. During the hospitalization, the patient’s condition improved quickly and after a few days he left the hospital without the signs of permanent damage to the heart muscle.

PP23 Accuracy of emergency medical services (EMS) telephone triage in identifying acute coronary syndrome (ACS) for chest pain patients. A systematic review abstract

2021 ◽  
Vol 38 (9) ◽  
pp. A10.2-A10
Author(s):  
Ahmed Alotaibi ◽  
Abdulrhman Alghamdi ◽  
Charles Reynard ◽  
Richard Body
Keyword(s):  
Systematic Review ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Prediction Models ◽  
Meta Analysis ◽  
Final Diagnosis ◽  
Telephone Triage ◽  
Coronary Syndrome ◽  
Life Threatening ◽  
Pain Patients

IntroductionChest pain is one of the most common reasons for ambulance callouts and presentation to Emergency Departments (EDs). Differentiating patients with serious conditions (e.g. acute coronary syndrome [ACS]) from the majority, who have self-limiting, non-cardiac conditions is extremely challenging. This causes over-triage and over-use of healthcare resources. We aimed to systematically review existing evidence on the accuracy of emergency telephone triage to detect ACS or life-threatening conditions associated with chest pain.MethodsWe conducted a systematic review in accordance with PRISMA guidelines. Two independent investigators searched the Embase, Medline, and Cinahl databases for relevant papers. We included retrospective and prospective cohort studies written in English and investigating EMS telephone triage for chest pain patients linked with final diagnosis of ACS. Studies were summarised in a narrative format as the data were not suitable for meta-analysis.ResultIn total, 553 studies were identified from the literature search and cross-referencing. After excluding 550 studies, three were eligible for inclusion. Among those 3 studies, there are different prediction models developed by authors with variation in variables to detect ACS. The result showed that dispatch triage tools have good sensitivity to detect ACS and life-threatening conditions although they are used to triage sign and symptoms rather than diagnosing the patients. On the other hand, prediction models were built to detect ACS and life-threatening conditions and therefore it showed better sensitivity and NPV.ConclusionEMS dispatch systems accuracy for ACS and life-threatening conditions associated with chest pain is good. Since the dispatch tools were built to triage ambulance response priority based on sign and symptoms, this led to over triage among non-life-threatening chest pain patients. Over triage were slightly reduced by deriving prediction models and showed better sensitivity.

scholarly journals Kounis syndrome uncovers severe coronary disease: an unusual case of acute coronary syndrome secondary to allergic coronary vasospasm

2019 ◽  
Vol 12 (12) ◽  
pp. e232472
Author(s):  
Luca Conti ◽  
Kelly Gatt ◽  
Christopher Zammit ◽  
Karen Cassar
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
High Signal ◽  
Type I ◽  
Kounis Syndrome ◽  
Coronary Syndrome ◽  
Triple Vessel Disease ◽  
Appropriate Treatment ◽  
St Elevation ◽  
Type I Hypersensitivity

Acute coronary syndrome occurring during the course of a type I hypersensitivity reaction constitutes Kounis syndrome. We report a case of a 64-year-old man who presented with a non-ST elevation myocardial infarction and peripheral blood eosinophilia. He had rhinitis and constitutional symptoms for several days prior to presentation. Blood investigations revealed moderate eosinophilia and elevated IgE levels. A cardiac MRI showed generalised oedema with a subtle wall motion abnormality in basal inferior/inferolateral wall, and subendocardial high signal on late gadolinium enhancement suggesting a localised myocardial infarction. A coronary angiogram then revealed triple vessel disease. A diagnosis of Kounis syndrome was made. Within days of starting appropriate treatment, the patient’s eosinophil count returned to normal with improvement of clinical picture.

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