Two Cardiac Arrests that Occurred after the Administration of Sugammadex: A Case of Kounis Syndrome

Kounis syndrome is a form of acute coronary syndrome caused by allergic reactions. No cases of cardiac arrest caused by Kounis syndrome that arose after the administration of sugammadex have been reported. A 71-year-old female suffered two cardiac arrests. The first occurred after sugammadex was administered at the end of an operation for a right radial distal fracture. The patient was resuscitated and transferred to our intensive care unit. She was subsequently discharged home. Five months later, she suffered a second cardiac arrest after sugammadex was administered at the end of an operation for a right femoral neck fracture at our hospital. Urgent coronary angiography revealed multiple coronary spasms. Kounis syndrome was diagnosed based on the patient’s elevated serum trypsin levels and a positive result in a skin allergy test of sugammadex. In cases of cardiac arrest with unclear etiologies, Kounis syndrome should be considered.

Download Full-text

Intraoperative Anaphylactic Shock Following Cefuroxime-Axetil Routine Test Case report and literature review

Revista de Chimie ◽

10.37358/rc.19.3.7032 ◽

2019 ◽

Vol 70 (3) ◽

pp. 925-928

Author(s):

Mirela Tiglis ◽

Andreea Mester ◽

Tudor Hurmuzache ◽

Camelia Cristina Diaconu ◽

Razvan Ion Florin Dragomirescu ◽

...

Keyword(s):

Cardiac Arrest ◽

Anaphylactic Shock ◽

Perioperative Period ◽

Cefuroxime Axetil ◽

Test Case ◽

Allergic Reactions ◽

Routine Test ◽

Kounis Syndrome ◽

Coronary Syndrome ◽

Cardio Vascular

Approximately 72% of patients with anaphylaxis present cardio-vascular manifestations, with only few reported cases of cardiogenic shock and cardiac arrest. Cephalosporins are the most used antibiotics for prophylaxis in the perioperative period with a prevalence of allergic reactions between 1-3%. Cefuroxime, a second-generation semisynthetic cephalosporin, presents relatively rare anaphylactic reactions (0.015%). Kounis syndrome is characterized by appearance of acute coronary syndrome in the presence of platelets, basophils or mast cells activation, due to an allergic reaction, hypersensitivity, anaphylactic reaction or shock. We report a rare case of a 53-year-old female patient with intraoperative anaphylactic shock following Cefuroxime-axetil routine test, complicated with Kounis syndrome and finally with cardiac arrest.

Download Full-text

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

Cardiology in the Young ◽

10.1017/s1047951121003838 ◽

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.

Download Full-text

Allergic acute coronary syndrome (Kounis syndrome) and sudden cardiac arrest due to cefoperazone-sulbactam in a patient with acute pancreatitis

Medicine: Case Reports and Study Protocols ◽

10.1097/md9.0000000000000024 ◽

2020 ◽

Vol 1 (1) ◽

pp. e0024

Author(s):

Ken Ito ◽

Tsuyoshi ito ◽

Hiroshi Fujita ◽

Kazuki Hayashi ◽

Tomonori Sugiura ◽

...

Keyword(s):

Acute Pancreatitis ◽

Acute Coronary Syndrome ◽

Cardiac Arrest ◽

Sudden Cardiac Arrest ◽

Kounis Syndrome ◽

Coronary Syndrome

Download Full-text

Contrast Media Induced Kounis Syndrome: A Case Report

Diagnostics ◽

10.3390/diagnostics9040154 ◽

2019 ◽

Vol 9 (4) ◽

pp. 154

Author(s):

Da-Sen Chien ◽

Andy Po-Yi Tsai ◽

Po-Chen Lin ◽

Giou-Teng Yiang ◽

Meng-Yu Wu

Keyword(s):

Blood Pressure ◽

Cardiac Arrest ◽

Contrast Media ◽

Cardiac Dysfunction ◽

Plaque Rupture ◽

Coronary Spasm ◽

Allergic Reactions ◽

Timely Manner ◽

Kounis Syndrome ◽

Accompanying Symptoms

Kounis syndrome is a rare anaphylactic reaction leading to coronary spasm, acute plaque rupture, or intrastent stenosis. Many types of medicine or environmental factors can potentially trigger Kounis syndrome by mast cell allergic reactions. In severe Kounis syndrome, reduced blood pressure or cardiac arrest may be accompanying symptoms. The treatment strategy for Kounis syndrome is usually difficult due to both cardiac dysfunction and allergic reactions. The delay to intervention to break the vicious circle may cause catastrophic complications. Therefore, early diagnosis is critical for physicians to outline detailed etiology for prevention and treat the cardiac and allergic symptoms in a timely manner. Here, we describe a case presenting rare severe Kounis syndrome with cardiac arrest which occurred after the administration of a contrast media.

Download Full-text

Kounis syndrome secondary to nimesulide ingestion: a case report

The Egyptian Heart Journal ◽

10.1186/s43044-021-00233-x ◽

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.

Download Full-text

The effect of the COVID-19 pandemic on acute coronary syndrome hospitalizations and out-of-hospital cardiac arrest in Greece

Public Health ◽

10.1016/j.puhe.2020.12.006 ◽

2020 ◽

Author(s):

Chris J. .Kapelios ◽

Christos Siafarikas ◽

Maria Bonou ◽

Stavros Liatis ◽

John Barbetseas

Keyword(s):

Acute Coronary Syndrome ◽

Cardiac Arrest ◽

Coronary Syndrome ◽

Hospital Cardiac Arrest

Download Full-text

Abstract 11324: Immediate Percutaneous Coronary Intervention in Patients with Refractory Out of Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.144.suppl_2.11324 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Daniel Rob ◽

Jana Smalcova ◽

Tomas Kovarnik ◽

David Zemanek ◽

Ales Kral ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Cardiac Arrest ◽

Lower Risk ◽

Coronary Intervention ◽

Post Hoc Analysis ◽

Risk Of Death ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

Post Hoc ◽

Hospital Cardiac Arrest

Background: An increasing number of cardiac centres are using immediate percutaneous coronary intervention (PCI) and extracorporeal cardiopulmonary resuscitation (ECPR) in patients with refractory out of hospital cardiac arrest (r-OHCA). Published evidence regarding PCI in OHCA has been mainly reporting to patients with early return of spontaneous circulation and the influence of PCI and ECPR on survival in the population of patients with r-OHCA and acute coronary syndrome (ACS) remains unclear. Methods: In this post hoc analysis of the randomized r-OHCA trial, all patients with ACS as a cause of r-OHCA were included. The effect of successful PCI and ECPR on 180-days survival was examined using Kaplan-Meier estimates and multivariable Cox regression. Results: In total, 256 patients were evaluated in Prague OHCA study and 127 (49.6 %) had ACS as the cause of r-OHCA constituting current study population. The mean age was 58 years (46.3-64) and duration of resuscitation was 52.5 minutes (36.5-68). ECPR was used in 51 (40.2 %) of patients. Immediate PCI was performed in 86 (67.7%) patients and TIMI flow 2 or 3 was achieved in 75 (87.2%) patients. The overall 180-days survival of patients with successful PCI was 40 % compared to 7.7 % with no or failed immediate PCI (log-rank p < 0.001). After adjustment for confounders, successful PCI was associated with a lower risk of death (HR 0.47, CI 0.24-0.93, p = 0.031). Likewise, ECPR was associated with a lower risk of death (HR 0.11, CI 0.05-0.24, p< 0.001). Conclusion: In this post hoc analysis of the randomized r-OHCA trial, successful immediate PCI as well as ECPR were associated with improved 180-days survival in patients with r-OHCA due to ACS.

Download Full-text

Abstract 15210: Do Idiopathic Ventricular Fibrillation and Brugada Syndrome Patients Have Favor Outcomes in the Targeted Temperature Management Era?

Circulation ◽

10.1161/circ.142.suppl_3.15210 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Eisuke Kagawa ◽

Masaya Kato ◽

Noboru Oda ◽

Eiji Kunita ◽

Michiaki NAGAI ◽

...

Keyword(s):

Cardiac Arrest ◽

Survival Rate ◽

Ventricular Fibrillation ◽

Brugada Syndrome ◽

Cardiac Dysfunction ◽

Targeted Temperature Management ◽

Temperature Management ◽

Circulatory Support ◽

Idiopathic Ventricular Fibrillation ◽

Coronary Syndrome

Introduction: Idiopathic ventricular fibrillation (IVF) including Brugada syndrome (BS) is one of causes of cardiac arrest without prior overt cardiac dysfunction. Hypothesis: We assessed the hypothesis that patents of IVF had favor outcomes than those of non-IVF after cardiac arrest treated with targeted temperature management (TTM). Methods: Patients who were treated with TTM after cardiac arrest between 2000 and 2019 were enrolled in the study. Patients were divided into 2 groups according to whether the patients were diagnosed as IVF or not. The patients treated with TTM were routinely performed coronary angiography. Results: Among the study patients (N = 306), 35 (11%) patients were IVF and 7 were BS. The patients of the IVF group were significantly younger (median 53 y vs. 64 y) than those of the non-IVF group. The prevalence of initial rhythm was shockable (69% vs. 47%, P = 0.02) was significantly higher in the patients of the IVF group than those of the non-IVF group. Among the patients in the non-IVF group, 114 patients (42%) were diagnosed as acute coronary syndrome and 93 patients (35%) were treated with coronary revascularization. The prevalence of male sex (77% vs 74%, P = 0.70) and witnessed to arrest (80% vs. 81%, P = 0.87), and low-flow time (29 min vs. 38 min [20 - 43 min vs. 21 - 52 min, P = 0.15]) were similar between the 2 groups. The prevalence of performing extracorporeal resuscitation (9% s 43%, P < 0.001) were lower in the patients of the IVF group. The 8-y survival rate were shown in the figure. All of the BS patients were witnessed arrest and were discharged without severe neurological deficit. The IVF as the cause of arrest was independently associated with 8-y survival. Conclusions: The patients of IVF had favor outcomes than those of non-VF. One of causes may be the lower prevalence of requiring extracorporeal circulatory support due to less cardiac dysfunction. The patients of BS had the tendency toward higher survival rate than those of non-BS IVF patients.

Download Full-text