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.

State-of-the-art diagnosis of myocardial infarction

Diagnosis ◽  
2016 ◽  
Vol 3 (4) ◽  
pp. 137-142 ◽  
Author(s):  
Mehrshad Vafaie
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Necrosis ◽  
High Sensitivity ◽  
Regional Wall Motion ◽  
Cardiac Biomarkers ◽  
Risk Scores ◽  
Optimal Timing ◽  
Reference Limit ◽  
Coronary Syndrome ◽  
Definition Of

AbstractThe current version of the Universal Definition of Myocardial Infarction (MI) was published in 2012. An acute myocardial infarction (AMI) is characterized by evidence of myocardial necrosis in a clinical setting of acute myocardial ischemia. Diagnostic criteria include a rise and/or fall of serially tested cardiac biomarkers (preferentially cardiac troponins) with at least one value above the 99th percentile of the upper reference limit combined with symptoms of ischemia, new changes on electrocardiogram (ECG), imaging evidence of a new loss of viable myocardium or new regional wall motion abnormalities or the identification of an intracoronary thrombus by angiography or autopsy. Compared to previous versions, the current definition of MI includes minor modifications regarding ECG criteria and subtypes of MI as well as the use of cardiac imaging and high sensitivity troponin assays. This article summarizes the Universal MI definition and includes recommendations from the current guidelines for the management of patients with acute coronary syndrome. Strategies for “early rule-in” and “rule-out” of non-ST-elevation MI with high sensitivity cardiac troponin assays, risk scores for assessment of ischemic and bleeding risk and criteria for optimal timing of angiography are presented.

scholarly journals A Comparative Study on Short-term Clinical Outcome in Acute Coronary Syndrome

2017 ◽  
Vol 13 (1) ◽  
pp. 22-27
Author(s):  
Syeda Aleya Sultana ◽  
Syed Asif Iqbal ◽  
Md Abdul Malek ◽  
Md Wali Ur Rahman ◽  
Abu Yusuf Md Shahidul Alam ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Wall Motion ◽  
Regional Wall Motion ◽  
Coronary Intervention ◽  
Short Term ◽  
Regional Wall ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Acute Mi

Introduction: Coronary artery diseases are currently the major cause of death in developing countries. Acute coronary syndrome (ACS) is defined as any group of clinical symptoms compatible with acute myocardial ischemia and covers the spectrum of clinical conditions ranging from unstable angina (UA) to non-ST elevation myocardial infarction (NSTEMI) to STelevation myocardial infarction (STEMI). Accurate diagnosis and management of ACS has life-saving implications of its outcome. Objective: To compare the outcomes of STEMI and NSTEMI in a percutaneous coronary intervention (PCI) capable centre. Materials and Methods: The patients who undergone percutaneous coronary intervention (PCI) in Combined Military Hospital, Dhaka were considered from January 2013 to January 2017. Diagnosis of acute MI was based on the clinical presentation, electrocardiogram (ECG) and raised highly sensitive troponin I. Acute MI patients were classified into 2 groups, STEMI and NSTEMI. Their coronary risk factors, co-morbidity, ECG, echocardiogram, coronary angiographic (CAG) findings and short-term outcomes were collected. All statistical data were analysed by SPSS 22.0 software. Results: There were 464 patients enrolled for analysis. Among them, 208(44.8%) patients had STEMI and 256(55.2%) had NSTEMI. The ratio of male/female was greater in STEMI as compared to NSTEMI (4.0 vs 1.9; p=0.041). Among NSTEMI patients, 88(34.4%) had ST depression, 168(65.6%) patients had other ECG changes like T wave abnormalities in 66(25.7%) and poor R-wave progression in 16(6.3%). NSTEMI patients had less regional wall motion abnormality on echo cardiogram (p=0.0045). As a complication heart failure (36% vs 9.3%), cardiogenic shock (16.8% vs 15.6%), atrial fibrillation (7.2 vs 0.78 %), ventricular tachycardia (2.8% vs 0.5%), reinfarction (3 % vs 0.78%) and death (2.4% vs 0.40%) were observed more in STEMI patients than NSTEMI respectively. NSTEMI patients had less regional wall motion abnormality on echocardiogram (p=0.0045). As a complication heart failure (36% vs 9.3%), cardiogenic shock (16.8% vs 15.6%), atrial fibrillation (7.2% vs 0.78%), ventricular tachycardia (2.8% vs 0.5%), reinfarction (3% vs 0.78%) and death (2.4% vs 0.40%) were observed more in STEMI patients than NSTEMI respectively. Coronary angiogram shows that left anterior descending artery was the most commonly involved artery in STEMI; however, the left circumflex artery or right coronary artery was involved more commonly in NSTEMI (p<0.001). Conclusion: The first step in successful treatment of acute MI depends on early diagnosis. Inspite of immediate management, STEMI had relatively worse outcome compared to NSTEMI. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 22-27

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.

Abstract 2838: Sequential Changes of Left Ventricular Systolic and Diastolic Synchronicity in Acute ST-Elevation Myocardial Infarction after Primary Coronary Intervention

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Seong-Mi Park ◽  
Yong-Hyun Kim ◽  
Soon-Jun Hong ◽  
Do-Sun Lim ◽  
Wan-Joo Shim
Keyword(s):  
Myocardial Infarction ◽  
Wall Motion ◽  
Chronic Phase ◽  
Regional Wall Motion ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Regional Wall ◽  
St Elevation

The aims of this study were to assess the sequential changes of left ventricular (LV) systolic and diastolic synchronicity in patients with acute myocardial infarction (AMI) and to assess their relation with LV recovery and remodeling. Forty-patients with acute ST-elevation MI were examined within 2days, 6weeks and 6months after primary coronary intervention. Fifteen-age matched subjects were enrolled for normal control. The time from the onset of QRS complex to peak systolic velocity (Ts) and to peak early diastolic velocity (Te) were measured on color-coded tissue Doppler imaging. To assess LV synchronicity, SDs of Ts (Ts-SD) and Te (Te-SD) of all 12 segments were calculated (within 2days, at 6weeks and 6months; SD1, SD2 and SD3, respectively). LV recovery was defined as the improvement of wall motion at least more than two segments at 6 weeks. In all AMI patients, the wall motion score index was 1.72±0.27 and LV ejection fraction was 45.9±9.9%. The Ts-SD1 was higher in AMI patients than in controls (45.4±13.5 vs 29.4±13.3ms, p<0.05), but Te-SD1 was not different (18.7±6.9 vs 16.2±10.0). Twenty-two patients (group1) showed a recovery and 18 patients (group2) showed no recovery. The Ts-SD1 was smaller in group1 than in group2 (43.4±12.6 vs 47.9±11.7 ms, p<0.05). In group1, Ts-SD were much decreased as follow up (Ts-SD2, 3; 36.6±14.0 and 31.1±9.5, respectively, p<0.05). In contrast, in group2, Ts-SD was not significantly changed (Ts-SD2,3; 46.7±13.2 and 43.7±8.8, respectively) but Te-SD was increased as follow up (Te-SD1,2,3; 17.8±5.5, 20.4±4.3 and 25.0±3.8, respectively, p<0.05). The LV end-diastolic and systolic volume were increased and the deceleration time of early diastolic mitral inflow velocity was shortened in group2 (p<0.05). This clinical study shows: 1) in acute phase, the regional wall motion abnormalities of AMI had an impact on LV systolic synchronicity; 2) the AMI patients with LV recovery showed better LV systolic synchronicity; 3) the LV systolic synchronicity became better as regional wall motion was improved; and 4) in chronic phase, the LV diastolic synchronicity became worse in AMI patients with no recovery, which might be related to LV remodeling and worsening of LV diastolic function.

Unstable Angina and Other Acute Coronary Syndromes

2013 ◽  
Author(s):  
R Scott Wright ◽  
Joseph G Murphy
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Risk Stratification ◽  
Unstable Angina ◽  
The United States ◽  
Cardiac Biomarkers ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Patients with coronary artery disease (CAD) present clinically when their disease enters an unstable phase known as an acute coronary syndrome (ACS), in which the cap of a previously stable atheromatous coronary plaque ruptures or erodes, which in turn activates a thrombotic cascade that may lead to coronary artery occlusion, myocardial infarction (MI), cardiogenic shock, and patient death. There are nearly 2 million episodes of ACS in the United States annually; it is the most common reason for hospitalization with CAD and is the leading cause of death in the developed world. ACS patients include those with unstable angina (UA), non–ST segment elevation myocardial infarction (non-STEMI), and ST segment elevation myocardial infarction (STEMI) and patients who die suddenly of an arrhythmia precipitated by coronary occlusion. The distinction among various ACS subgroups reflects varying characteristics of clinical presentation (presence or absence of elevated cardiac biomarkers) and the type of electrocardiographic (ECG) changes manifested on the initial ECG at the time of hospitalization. This chapter focuses on UA and non-STEMI. A graph outlines mortality risks faced by patients with varying degrees of renal insufficiency. An algorithm describes the suggested management of patients admitted with UA or non-STEMI. Tables describe the risk stratification of the patient with chest pain, categories of Killip class, examination findings of a patient with high-risk ACS, diagnosis of MI, causes of troponin elevation other than ischemic heart disease, initial risk stratification of ACS patients, and long-term medical therapies and goals in ACS patients. This review contains 2 highly rendered figures, 11 tables, and 76 references.

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.

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.

Abstract 2832: Which Cardiac Marker is Most Useful to Predict Final Infarct Size and Cardiac Function Following Primary Percutaneous Coronary Intervention For Acute Myocardial Infarction?

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Stanley Chia ◽  
O. Christopher Raffel ◽  
Faisal Merchant ◽  
Frans J Wackers ◽  
Fred Senatore ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Infarct Size ◽  
Troponin I ◽  
Troponin T ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Primary Pci ◽  
Percutaneous Coronary

Background: Assessment of cardiac biomarker release has been traditionally used to estimate the size of myocardial damage after acute myocardial infarction (AMI). However, the significance of cardiac biomarkers in the setting of primary percutaneous coronary intervention (PCI) has not been systematically studied in a large patient cohort. We evaluated the usefulness of serial and single time-point measures of various cardiac biomarkers (creatine kinase (CK), CK-MB, troponin T and I) in predicting infarct size and left ventricular ejection fraction (LVEF) after primary PCI. Methods: EVOLVE (Evaluation of MCC-135 for Left Ventricular Salvage in AMI) was a randomized double-blind, placebo-controlled trial comparing the efficacy of intracellular calcium modulator as an adjunct to primary PCI in patients with first large AMI. Levels of cardiac biomarkers (CK, CK-MB mass, troponin T and I) were determined in 375 patients at baseline before PCI and 2, 4, 12, 24, 48 and 72 hours thereafter. Single photon emission computed tomography imaging was performed to measure infarct size and LVEF on day 5. Results: Area under curve and peak concentrations of all cardiac markers: CK, CK-MB mass, troponin T and troponin I were significantly correlated with myocardial infarct size and LVEF determined on day 5 (Spearman correlation, all P< 0.001; Table ). Troponin I, however provided the best predictor and a single measure at 72 hr was a strong indicator of both infarct size and LVEF. Using receiver operator characteristics curve, troponin I cutoff value of >55 pg/mL at 72 hr has 90% sensitivity and 70% specificity for detection of large infarct size≥10% ( c =0.88; P< 0.001). Conclusions: Plasma levels of CK, CK-MB, troponin T and troponin I remain useful predictors of infarct size and cardiac function in the era of primary PCI for AMI. A single measurement of circulating troponin I at 72 hours can provide an effective and convenient indicator of infarct size and LVEF in clinical practice. Correlation of cardiac biomarkers with Day 5 SPECT determined infarct size and LVEF

Sign in / Sign up

Export Citation Format

Share Document