scholarly journals Kounis Syndrome as First Manifestation of Allergic Sensitization

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
D. Forlani ◽  
G. Scarano ◽  
A. D’Alleva ◽  
M. Di Marco ◽  
L. Paloscia ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Allergic Reaction ◽  
Allergic Sensitization ◽  
Cardiac Biomarkers ◽  
Antibiotic Administration ◽  
Kounis Syndrome ◽  
Wasp Sting ◽  
Acute Urticaria ◽  
Coronary Syndrome ◽  
Patients At Risk

Mast cells are abundant in the heart, among myocardial fibers, around coronary arteries, within arterial intima and intramural vessels, and in atherosclerotic plaques. Their mediators can be released during anaphylaxis and be responsible for acute coronary syndrome. This condition has been described as Kounis syndrome (KS). We report three cases of acute myocardial ischemia, which fulfill the definition for KS. In Cases 1 and 2, the association of intense chest pain with acute urticaria after an allergenic contact (wasp sting and betalactam antibiotic administration, respectively) was suspected to be an attack of angina related to an allergic reaction. No signs of an allergic reaction were observed in Case 3, but only the history of a wasp sting suggested its relationship to loss of consciousness and heart ischemia when hypersensitivity to venom was ascertained. These cases strongly recommend measurement of anaphylactic biomarkers, such as tryptase, during acute coronary syndromes to detect the possible involvement of an allergic reaction. Conversely, measurement of cardiac biomarkers during anaphylaxis, even without obvious signs of myocardial ischemia, might identify patients at risk of myocardial injury.

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.

scholarly journals CLINICAL CASE OF ALLERGIC ACUTE CORONARY SYNDROME (KOUNIS SYNDROME) CAUSED BY COLD URTICARIA

2021 ◽  
Vol 19 (2) ◽  
pp. 229-235
Author(s):  
L. V. Kalatsei ◽  
◽  
V. A. Snezhitskiy ◽  
S. N. Hrib ◽  
T. G. Liskovich ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Allergic Reaction ◽  
Clinical Case ◽  
Rare Variants ◽  
Pathophysiological Mechanism ◽  
Kounis Syndrome ◽  
Cold Urticaria ◽  
Coronary Syndrome ◽  
The Given ◽  
Allergic Manifestations

Kounis syndrome is one of the rare variants of acute coronary syndrome that occurs as a result of an allergic reaction. Its main pathophysiological mechanism is coronary vasospasm. Clinically, Kounis syndrome is manifested by symptoms of both an allergic reaction and an acute coronary syndrome, and its treatment is not an easy task, since both cardiac and allergic manifestations must be treated at the same time. In the given article we describe a clinical case of diagnosis and successful treatment of Kounis syndrome caused by cold urticaria in a 58-year-old patient who was hospitalized to the Grodno Regional Clinical Cardiology Center.

scholarly journals Abnormal Cardiac Biomarkers in Patients with Systemic Lupus Erythematosus and No Prior Heart Disease: A Consequence of Antimalarials?

2018 ◽  
Vol 46 (1) ◽  
pp. 64-69 ◽  
Author(s):  
Konstantinos Tselios ◽  
Dafna D. Gladman ◽  
Paula Harvey ◽  
Shadi Akhtari ◽  
Jiandong Su ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Heart Disease ◽  
Lupus Erythematosus ◽  
Troponin I ◽  
Cardiac Biomarkers ◽  
Systemic Lupus ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Patients At Risk

Objective.Cardiac involvement in systemic lupus erythematosus (SLE) is often undiagnosed in its early phases. Specific heart biomarkers may identify patients at risk. We sought to investigate the prevalence and associated factors for such biomarkers in SLE.Methods.Brain natriuretic peptide (BNP) and cardiac troponin I (cTnI) were measured simultaneously in 151 consecutive patients with no history of heart disease or pulmonary arterial hypertension (PAH). None had electrocardiographic abnormalities suggestive of acute coronary syndrome. Cross-sectional comparisons and logistic regression analyses were performed. Patients with abnormal biomarkers were investigated to delineate the specific cause.Results.Sixteen patients (16/151, 10.6%) had elevated BNP, and 9 of them also had abnormal cTnI. Compared to subjects with normal biomarkers, they were older, had longer disease and antimalarial (AM) use duration, and more frequently persistent creatine phosphokinase (CPK) elevation. Multivariable regression analysis showed prolonged AM treatment (> 5.6 yrs) and persistent CPK elevation to be important predictors for elevated cardiac biomarkers. Six patients were diagnosed with definite (based on endomyocardial biopsy, n = 2) or possible (based on cardiac magnetic resonance after exclusion of other causes) AM-induced cardiomyopathy (AMIC); all had both BNP and cTnI elevated. Alternative causes were identified in 5, while no definitive diagnosis could be made in the remaining patients.Conclusion.About 10% of patients with SLE had elevated myocardial biomarkers, in the absence of prior cardiac disease or PAH. One-third of them were diagnosed with AMIC. Prolonged AM therapy and persistent CPK elevation conferred an increased risk for abnormal BNP and cTnI, which might predict AMIC.

scholarly journals A Case with Repeated Recurrent Acute Coronary Syndrome due to Pseudoephedrine Use: Kounis Syndrome

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Metin Çeliker ◽  
Mustafa Tuncer ◽  
Ali Şekeralmaz
Keyword(s):  
Acute Coronary Syndrome ◽  
Environmental Factors ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Allergic Reaction ◽  
Upper Respiratory Tract ◽  
Kounis Syndrome ◽  
Common Cause ◽  
Coronary Syndrome ◽  
Upper Respiratory

Allergic reaction-associated acute coronary syndrome picture is defined as Kounis syndrome. Although drug use is the most common cause of allergic reaction, foods and environmental factors may also play a role in the etiology. Herein, a case with acute coronary syndrome that developed two times at 8-month interval due to pseudoephedrine use for upper respiratory tract infection is presented.

scholarly journals Kounis syndrome – an unusual etiology of acute myocardial infarction

2015 ◽  
Vol 10 (3) ◽  
pp. 295-299
Author(s):  
Vlad BĂTĂILĂ ◽  
◽  
Aura VÎJÎIAC ◽  
Lucian CÂLMÂC ◽  
Maria DOROBANŢU ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Conservative Approach ◽  
Inferior Myocardial Infarction ◽  
Kounis Syndrome ◽  
Wasp Sting ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Vasoactive Mediators ◽  
St Segment

Kounis syndrome is defined as an association between an acute coronary syndrome and acute systemic allergy involving vasoactive mediators released during the activation of the mast cells. A 79 year old woman arrives at the emergency department with syncope; she was stung by a wasp an hour before symptoms’ onset. Clinical examination was normal, excepet her left upper limb which had important edema. The ECG revealed ST-segment elevation in the inferior leads and negative T waves in the anterior leads. Emergency coronary angiography was performed, which revealed a 40% stenotic plaque on the mid LAD. A conservative approach was decided. The patient received standard anti-ischemic treatment and she was safely discharged after 6 days. We considered this case a Kounis syndrome induced by a wasp sting associated with a silent inferior myocardial infarction.

scholarly journals Metamizole-Induced Type I Kounis Syndrome

2021 ◽  
Author(s):  
Catarina Lameiras ◽  
Ana Corte-Real ◽  
Ana Órfão ◽  
Marta Mendes Lopes ◽  
Maria do Céu Dória
Keyword(s):  
Previous History ◽  
Clinical Manifestations ◽  
Type I ◽  
Kounis Syndrome ◽  
St Segment Elevation ◽  
Acute Urticaria ◽  
Coronary Syndrome ◽  
St Segment ◽  
Life Threatening ◽  
Cardiac Manifestations

Kounis syndrome (KS) is defined as acute coronary syndrome (ACS) triggered by mast cell and platelet activation in the setting of allergic or anaphylactic insults. KS is a unique and complex cause of ACS and many cases may be missed due to its highly variable clinical manifestations. In this report, we present a case of KS type I triggered by metamizole in the absence of a previous history of allergy to this drug. Following the administration of metamizole, the patient developed generalized acute urticaria, chest pain and diaphoresis. Electrocardiography (ECG) showed ST-segment elevation suggestive of myocardial infarction complicated by ventricular tachycardia. No coronary disease was observed on coronary angiography. The cardiac manifestations of KS may be life-threatening, and so it is important to appropriately recognize and treat this condition.

scholarly journals Kounis Syndrome Secondary to Medicine-Induced Hypersensitivity

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Parackrama Karunathilake ◽  
Udaya Ralapanawa ◽  
Thilak Jayalath ◽  
Shamali Abeyagunawardena
Keyword(s):  
Allergic Reaction ◽  
Troponin I ◽  
Complete Recovery ◽  
Isosorbide Mononitrate ◽  
Kounis Syndrome ◽  
Coronary Syndrome ◽  
St Segment ◽  
Daily Dose ◽  
Threatening Condition ◽  
Life Threatening

Introduction. Kounis syndrome is the concurrence of an acute coronary syndrome (ACS) caused by coronary vasospasms, acute myocardial infarctions, or stent thromboses in case of allergic or hypersensitivity reactions. Kounis syndrome is mediated by mast cells that interact with macrophages and T-lymphocytes, causing degranulation and inflammation with cytokine release. It is a life-threatening condition that has many trigger factors and is most commonly caused by medicines. Case Presentation. A 71-year-old male was admitted with a fever of five days’ duration associated with cellulitis, for which he had been treated with clindamycin and flucloxacillin before admission. He was a diagnosed patient with hypertension and dyslipidemia five years ago. After taking the antibiotics, he had developed generalized itching followed by urticaria suggesting an allergic reaction. Therefore, he was admitted to the hospital. After admission, he developed an ischaemic-type chest pain associated with autonomic symptoms and shortness of breath. An immediate ECG was taken that showed ST-segment depressions in the chest leads V4–V6, confirmed by a repeat ECG. Troponin I was 8 ng/mL. Acute management of ACS was started, and prednisolone 10 mg daily dose was given. After complete recovery, the patient was discharged with aspirin, clopidogrel, atorvastatin, metoprolol, losartan, isosorbide mononitrate, and nicorandil. Prednisolone 10 mg daily dose was given for five days after discharge. Conclusion. In immediate hypersensitivity, with persistent cardiovascular instability, Kounis syndrome should be considered, and an electrocardiogram and other appropriate assessments and treatments should be initiated. Prompt management of the allergic reaction and the ACS is vital for a better outcome of Kounis syndrome.

scholarly journals From Wellens To Kounis Syndrome: An Unlucky Patient

2020 ◽  
Author(s):  
Ossama Maadarani ◽  
Zouheir Bitar ◽  
Sania Shoeb ◽  
Jadan Alsaddah
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Allergic Reaction ◽  
Contrast Media ◽  
Coronary Intervention ◽  
The Other ◽  
Ecg Changes ◽  
Kounis Syndrome ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Wellens syndrome (WS) is identified by ECG changes in the precordial leads after resolution of angina chest pain. WS indicates critical stenosis of the proximal left anterior descending (LAD) artery. On the other hand, Kounis syndrome (KS) is an allergic reaction to various substances resulting in acute coronary syndrome. Contrast media can trigger the allergic reaction associated with KS. We describe a patient with WS who developed an allergic reaction to contrast media after percutaneous coronary intervention and experienced recurren myocardial infarction on re-exposure.

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.

scholarly journals Kounis syndrome secondary to nimesulide ingestion: a case report

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Yamasandi Siddegowda Shrimanth ◽  
Krishna Santosh Vemuri ◽  
Atit A. Gawalkar ◽  
Soumitra Ghosh ◽  
Jyothi Vijay ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hypersensitivity Reaction ◽  
Regional Wall Motion ◽  
Maculopapular Rash ◽  
Coronary Intervention ◽  
Cardiac Biomarkers ◽  
Drug Eluting Stent ◽  
Allergic Reactions ◽  
Kounis Syndrome ◽  
Coronary Syndrome

Abstract Background Kounis syndrome, also known as "allergic myocardial infarction," is a rare co-occurrence of acute coronary syndrome (ACS) in the setting of hypersensitivity reaction to any agent. Non-steroidal anti-inflammatory drugs (NSAIDs) like are often implicated in causing allergic reactions. Here, we present a case of anterior wall myocardial infarction (AWMI) occurred following angioedema secondary to intake of Nimesulide, not described earlier in literature. Case presentation A 45-year-old female developed generalized pruritic, erythematous maculopapular rash, facial puffiness, oral ulcers and hoarseness of voice within few hours following consumption of Nimesulide for fever and body-ache. Due to development of hypotension, electrocardiogram (ECG) was done, which revealed ST elevation in V2–V6, with marked elevation of troponin (TnI) and creatine kinase (CK-MB). He had no chest pain or shortness of breath. Echocardiography showed regional wall motion (RWMA) abnormality in left anterior descending artery (LAD) territory with an ejection fraction of 25%. Coronary angiography showed a complete thrombotic cutoff of LAD, for which Tirofiban infusion was started to decrease thrombus burden. Repeat angiography on next day showed 80% lesion in proximal LAD for which she underwent revascularization with a drug-eluting stent. The patient later showed improvement in cardiac function at 8 months of follow-up. Conclusions The occurrence of ACS requiring percutaneous coronary intervention (PCI) in the setting of allergic reactions is rarely reported in the literature. One should be aware of the rare possibility of Kounis syndrome in the setting of hypersensitivity reaction when accompanying features of symptoms suggestive of coronary artery disease co-exists. When indicated, ECG monitoring and cardiac biomarkers in patients with allergic responses help to identify this rare and treatable condition.

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