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1.
Am J Emerg Med ; 52: 203-207, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34959022

RESUMO

BACKGROUND: Understanding the relationship between contrast agents and Kounis syndrome (KS) is mainly based on case reports. The purpose of this research is to explore the clinical characteristics of contrast media induced KS. METHODS: We searched for contrast-induced KS case reports through Chinese and English databases from 1991 to October 31, 2021. RESULTS: A total of 26 patients (19 men and 7 women,) were included, with a median age of 60 years (range 30-83). The contrast agents that cause KS mainly included gadolinium-based contrast agent (7 cases), iodine-containing contrast media (12 cases). KS mainly occurred within 30 min after administration and mainly manifests as chest pain and allergic reactions. Electrocardiogram (ECG) mainly showed ST elevation. Echocardiography mainly revealed normal. Coronary angiography showed normal, coronary vasospasm, stent thrombosis, occlusion and stenosis. After treatment with steroids, antihistamines and anti-ischemic therapy, 24 patients recovered completely and 2 patients died. CONCLUSIONS: KS is a rare adverse reaction of contrast media. Radiologists should recognize this rare but serious disease to ensure rapid diagnosis and proper management.


Assuntos
Meios de Contraste/efeitos adversos , Síndrome de Kounis/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
2.
Emerg Med Clin North Am ; 40(1): 69-78, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34782092

RESUMO

Acute coronary syndrome (ACS) in the setting of an allergic/immunologic reaction is known as Kounis syndrome. It is an underdiagnosed and underrecognized disease entity. One must keep a high index of suspicions when managing a patient presenting with cardiac as well as allergic symptoms. There are 3 main variants to the syndrome. Treating the allergic reaction may alleviate the pain; however, ACS guidelines should be followed if cardiac ischemia is present.


Assuntos
Síndrome de Kounis/complicações , Síndrome de Kounis/imunologia , Humanos , Síndrome de Kounis/fisiopatologia
5.
Eur Rev Med Pharmacol Sci ; 24(22): 11768-11772, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33275246

RESUMO

Occurrence of chest pain during an allergic reaction is a typical manifestation of the Kounis syndrome, defined in 1991 by Nicholas Kounis and George Zavras as an "allergic angina", whose clinical course can range from a simple coronary spasm without troponin elevation to an acute myocardial infarction with all the possible complications, including sudden cardiac death. The full pathogenetic mechanisms are still not fully understood, and this is one of the reasons why it is underestimated in the emergency practice; on the other hand, an immediate identification and an appropriate treatment could prevent the occurrence of the most serious consequences. In this article we report the case study of a patient with Kounis syndrome and we review the literature on this uncommon disease; it is fundamental to consider Kounis syndrome as a possible cause of chest pain in patients admitted in the emergency department with an ongoing allergic reaction.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Dor no Peito/diagnóstico , Eletrocardiografia , Síndrome de Kounis/diagnóstico , Síndrome Coronariana Aguda/tratamento farmacológico , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Dor no Peito/tratamento farmacológico , Dor no Peito/fisiopatologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Hipersensibilidade , Síndrome de Kounis/tratamento farmacológico , Síndrome de Kounis/fisiopatologia
6.
Can J Cardiol ; 36(6): 966.e5-966.e6, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32536377

RESUMO

Kounis syndrome was recognized as the concurrence of acute cardiovascular events with hypersensitivity reactions. We report a case of Kounis syndrome type III (coronary thrombosis) variant in a 48-year-old man who had experienced recurrent acute myocardial infarctions after scallion-induced hypersensitivity reactions. After appropriate antithrombotic, antihistamine, and reperfusion strategies, the patient was found to have elevated levels of immunoglobulin E and chronic urticaria. Upon administration of omalizumab, there was an improvement of chronic urticaria, a decrease in immunoglobulin E levels, and resolution of the ischemic attacks.


Assuntos
Urticária Crônica , Trombose Coronária , Hipersensibilidade Alimentar , Imunoglobulina E , Síndrome de Kounis , Omalizumab/administração & dosagem , Antialérgicos/administração & dosagem , Urticária Crônica/etiologia , Urticária Crônica/imunologia , Urticária Crônica/terapia , Trombose Coronária/etiologia , Trombose Coronária/imunologia , Trombose Coronária/prevenção & controle , Fibrinolíticos/uso terapêutico , Hipersensibilidade Alimentar/sangue , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade Alimentar/tratamento farmacológico , Alho/efeitos adversos , Humanos , Imunoglobulina E/sangue , Imunoglobulina E/imunologia , Síndrome de Kounis/etiologia , Síndrome de Kounis/fisiopatologia , Síndrome de Kounis/prevenção & controle , Síndrome de Kounis/terapia , Masculino , Pessoa de Meia-Idade , Cebolas/efeitos adversos , Intervenção Coronária Percutânea/métodos , Recidiva , Resultado do Tratamento
7.
Am J Emerg Med ; 38(2): 409.e5-409.e7, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31785976

RESUMO

Kounis syndrome is defined by the occurrence of an acute coronary syndrome (ACS) in the setting of an allergic, hypersensitivity or anaphylactic condition. Degranulation of mast cells and platelet activation leading to the release of multiple inflammatory mediators are thought to make the arterial circulation susceptible to acute cardiac events. It is an often underdiagnosed entity in the emergency setting, due to lack of awareness among emergency providers. Identifying Kounis syndrome is critical, since managing ACS differs from that of a classical acute myocardial infarction. We present the case of a 72-year old male patient with a history of stable coronary disease who presented to the emergency department with a diffuse pruritic rash and chest pain. Electrocardiogram showed ST elevation myocardial infarction. Urgent coronary angiography revealed total occlusion of the mid left anterior descending coronary artery which was treated with a drug eluting stent with an excellent outcome. The pruritic rash responded to treatment with intravenous corticosteroids and antihistamines; No allergens were identified. The patient's symptoms resolved and he had an uneventful hospitalization. The diagnosis of Kounis syndrome can complicate the management of acute allergic reactions. Special precautions should be taken by emergency physicians with regards to the administration of beta blockers, morphine and vasodilators, which may be detrimental in this setting.


Assuntos
Anafilaxia/complicações , Síndrome de Kounis/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Doença Aguda , Corticosteroides/administração & dosagem , Idoso , Dor no Peito/etiologia , Angiografia Coronária , Stents Farmacológicos , Eletrocardiografia , Serviço Hospitalar de Emergência , Exantema/etiologia , Humanos , Síndrome de Kounis/fisiopatologia , Masculino , Prurido/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia
9.
Turk Kardiyol Dern Ars ; 47(4): 324-328, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31219450

RESUMO

Isotretinoin is widely used in the treatment of acne vulgaris and other dermatological diseases. Numerous side effects have been reported in the literature. A myocardial bridge occurs when segments of the coronary artery create an intramyocardial tunnel. Atherosclerotic plaque formation frequently occurs in the segment proximal to a myocardial bridge. Coronary thrombus formation, which is often the cause of myocardial infarction in young patients, can be triggered by many factors. Kounis syndrome is described as acute coronary syndromes associated with allergic or hypersensitivity reactions. This article is a description of the case of a patient predisposed to the development of a thrombus by a myocardial bridge who was successfully treated for coronary thrombosis and which may represent a case of Kounis syndrome associated with isotretinoin use presented in the context of the relevant literature.


Assuntos
Fármacos Dermatológicos/efeitos adversos , Isotretinoína/efeitos adversos , Síndrome de Kounis/etiologia , Adulto , Doenças Cardiovasculares/induzido quimicamente , Eletrocardiografia , Humanos , Síndrome de Kounis/diagnóstico , Síndrome de Kounis/fisiopatologia , Masculino
10.
Balkan Med J ; 36(4): 212-221, 2019 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-31198019

RESUMO

Coronary symptoms associated with conditions related to mast cell activation and inflammatory cell interactions, such as those involving T-lymphocytes and macrophages, further inducing allergic, hypersensitivity, anaphylactic, or anaphylactic insults, are currently referred to as the Kounis syndrome. Kounis syndrome is caused by inflammatory mediators released during allergic insults, post-inflammatory cell activation, and interactions via multidirectional stimuli. A platelet subset of 20% with high- and low-affinity IgE surface receptors is also involved in this process. Kounis syndrome is not just a single-organ but also a complex multisystem and multi-organ arterial clinical condition; it affects the coronary, mesenteric, and cerebral arteries and is accompanied by allergy­hypersensitivity­anaphylaxis involving the skin, respiratory, and vascular systems in the context of anesthesia, surgery, radiology, oncology, or even dental and psychiatric medicine; further, it has significantly influences both morbidity and mortality. Kounis syndrome might be caused by numerous and continuously increasing causes, with broad clinical symptoms and signs, via multi-organ arterial system involvement, in patients of any age, thereby demonstrating predominant anaphylactic features in terms of a wide spectrum of mast cell-association disorders. Cardiac symptoms, such as chest pain, coronary vasospasm, angina pectoris, myocardial infarction, stent thrombosis, acute cardiac failure, and sudden cardiac death associated with subclinical, clinical, acute, or chronic allergic reactions, constitute the clinical manifestations of this syndrome. Since its first description, a common pathway between allergic and non-allergic coronary events has been demonstrated. The hypothesis is based on the existence of a much higher degree of mast cell degranulation at plaque erosion or rupture sites compared with at the adjacent areas or even more distant segments in post-acute myocardial infarction of non-allergic etiology. Although mast cell activation, differentiation, and mediator release takes days or weeks, the mast cell degranulation may occur just before any acute coronary event, further resulting in coronary artery vasoconstriction and atheromatous plaque rupture. It seems that medications and natural molecules stabilizing the mast cell membrane as well as monoclonal antibodies protecting the mast cell surface can emerge as novel therapeutic modalities for acute coronary and cerebrovascular event prevention.


Assuntos
Doença das Coronárias/etiologia , Síndrome de Kounis/etiologia , Mastócitos/enzimologia , Anafilaxia/enzimologia , Anafilaxia/etiologia , Doença das Coronárias/enzimologia , Humanos , Síndrome de Kounis/epidemiologia , Síndrome de Kounis/fisiopatologia , Mastócitos/metabolismo , Mastócitos/patologia , Mastocitose/complicações , Mastocitose/etiologia , Mastocitose/fisiopatologia
12.
Intern Med ; 58(2): 243-245, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30146563

RESUMO

A 78-year-old man with mild coronary arteriosclerosis on coronary CT angiography underwent MRI of the prostate with the administration of Gadolinium-based contrast agent (GBCA) (gadopentetate dimeglumine). He developed acute coronary syndrome immediately after the intravenous injection of GBCA, and recovered after the administration of nitroglycerine, atropine sulfate, and hydrocortisone. He was discharged on the ninth day of hospitalization without recurrent chest symptoms. This is the second reported case of Kounis syndrome caused by GBCA. Kounis syndrome caused by MR contrast media is rare, but we should recognize that all contrast agents have the potential to cause Kounis syndrome.


Assuntos
Síndrome Coronariana Aguda/induzido quimicamente , Arritmias Cardíacas/induzido quimicamente , Meios de Contraste/efeitos adversos , Gadolínio DTPA/efeitos adversos , Síndrome de Kounis/etiologia , Imageamento por Ressonância Magnética/métodos , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Eletrocardiografia , Humanos , Injeções Intravenosas , Síndrome de Kounis/fisiopatologia , Imageamento por Ressonância Magnética/efeitos adversos , Masculino , Próstata/diagnóstico por imagem
13.
G Ital Cardiol (Rome) ; 19(11): 655-657, 2018 Nov.
Artigo em Italiano | MEDLINE | ID: mdl-30425395

RESUMO

Ischemic heart disease can be caused by multiple factors. However, epidemiological studies have evidenced an association between hypereosinophilia and acute coronary syndrome, most frequently observed in the Kounis and Churg-Strauss syndromes. We here report the case of a 37-year-old man, who was admitted to our hospital for acute coronary syndrome, complicated by hypokinetic cardiac arrest with severe hypereosinophilia.


Assuntos
Síndrome Coronariana Aguda/etiologia , Síndrome de Churg-Strauss/diagnóstico , Parada Cardíaca/etiologia , Síndrome de Kounis/diagnóstico , Adulto , Síndrome de Churg-Strauss/fisiopatologia , Eosinofilia/etiologia , Humanos , Síndrome de Kounis/fisiopatologia , Masculino , Isquemia Miocárdica/etiologia
14.
Turk Kardiyol Dern Ars ; 46(3): 223-227, 2018 04.
Artigo em Turco | MEDLINE | ID: mdl-29664430

RESUMO

Kounis syndrome is defined as the clinical development of acute coronary syndrome caused by the activation of inflammatory cells due to an allergy, hypersensitivity, anaphylaxis, or anaphylactic reaction. Corticosteroids that are used in the treatment of many inflammatory conditions may paradoxically cause allergic reactions and even anaphylaxis. This article is a description of the case of a 52-yearold female patient who had a non-ST elevation myocardial infarction after the administration of triamcinolone that was relieved with antihistaminic treatment. The patient had been diagnosed with dermatitis at another medical center and injected with 40 mg/mL (intramuscular [IM]) of triamcinolone acetonide and developed chest pain 15 minutes after the first dose. Despite a normal physical examination and echocardiogram, laboratory tests revealed troponin positivity and an inferolateral ST depression was present on an electrocardiogram (ECG). The ECG findings and clinical symptoms resolved completely after conservative anti-ischemic treatment and antihistaminic therapy (pheniramine maleate 45.5 mg/2 mL, Avil ampoule, IV; Sanofi-Aventis, Paris, France) and coronary angiography evaluation of the arteries was normal. The heart, and in particular the coronary arteries, are among the organs that are most damaged during hypersensitivity reactions and anaphylaxis. Although Kounis syndrome is not a rare condition, few cases have been reported in clinical practice. The failure to recognize Kounis syndrome due to inadequately defined cases may lead to unwanted medical results. Kounis syndrome should be kept in mind in order to make a rapid and accurate diagnosis.


Assuntos
Anti-Inflamatórios/efeitos adversos , Dermatite/tratamento farmacológico , Síndrome de Kounis , Triancinolona/efeitos adversos , Anti-Inflamatórios/uso terapêutico , Eletrocardiografia , Feminino , Humanos , Síndrome de Kounis/diagnóstico , Síndrome de Kounis/etiologia , Síndrome de Kounis/fisiopatologia , Pessoa de Meia-Idade , Triancinolona/uso terapêutico
15.
BMC Cardiovasc Disord ; 18(1): 42, 2018 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-29486712

RESUMO

BACKGROUND: Kounis syndrome (KS) is the concurrence of acute coronary syndrome associated with mast-cell and platelet activation in the setting of hypersensitivity and allergic or anaphylactic insults. Many drugs and environmental exposures had been reported as inducers, but various inducers and the mechanism of KS remained unknown till now. The widely used traditional Chinese medicine (TCM) as a potential sensitizer were scarcely reported to induce allergic vasospasm due to the ignorance of the linkage between traditional medicine allergy and vasospasm. CASE PRESENTATION: We described 5 rare cases of KS including unreported triggers of TCM and abortion, reported the treatment strategy and 1~4 years' follow-up results, and tried to probe into the etiology of KS. Case 1 and case 2 for the first time reported acute ST-segment elevation myocardial infarction (STEMI) caused by Chinese herbs related allergic coronary vasospasm. Case 3 reported recurrent angina following allergen contact and wheezing, indicating the internal linkage of coronary vasospasm and allergic asthma. Case 4 described a childbearing-age woman suffered refractory ischemic chest pain due to coronary vasospasm in a special period of post-abortion, the attacks suddenly disappeared when her menopause recovered. Case 5 described an isolated episode of allergic coronary vasospasm under exposure of smoking and stress, which was successfully prevented by avoiding the exposures. CONCLUSION: Kounis syndrome is not rare but rarely recognized and under-diagnosed. It is necessary to recognize KS and various inducers, especially for the patients suffering refractory vasospastic cardiac attacks concentrating in special periods. Blood test of eosinophil might contribute to diagnose KS and anti-allergic agents might be helpful for controlling KS attacks.


Assuntos
Aborto Induzido/efeitos adversos , Síndrome Coronariana Aguda/etiologia , Vasos Coronários/efeitos dos fármacos , Medicamentos de Ervas Chinesas/efeitos adversos , Síndrome de Kounis/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Fumar/efeitos adversos , Estresse Psicológico/complicações , Vasoconstrição/efeitos dos fármacos , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/fisiopatologia , Adulto , Idoso , Angiografia Coronária , Vasos Coronários/fisiopatologia , Eletrocardiografia , Feminino , Humanos , Síndrome de Kounis/diagnóstico , Síndrome de Kounis/fisiopatologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia
16.
Pan Afr Med J ; 30: 301, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30637085

RESUMO

The Kounis-Zavras syndrome is defined as the coincidental occurrence of acute coronary events and hypersensitivity reactions following an allergic reaction including a mast-cell degranulation of vasospastic mediators. This report describes a case of Kounis-Zavras syndrome in the setting of aspirin-induced asthma also known as Samter-Beer triad combining nasal polyps, asthma, and aspirin allergy leading to vasospasm and myocardial infarction. All physicians should be aware of The Kounis syndrome and always keep that unique clinical entity in mind to recognize it promptly and direct the therapy at suppressing the allergic reaction.


Assuntos
Aspirina/efeitos adversos , Hipersensibilidade a Drogas/fisiopatologia , Síndrome de Kounis/diagnóstico , Aspirina/administração & dosagem , Asma/induzido quimicamente , Asma/imunologia , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/imunologia , Feminino , Humanos , Síndrome de Kounis/fisiopatologia , Mastócitos/imunologia , Pessoa de Meia-Idade , Infarto do Miocárdio/induzido quimicamente , Infarto do Miocárdio/imunologia , Pólipos Nasais/imunologia
17.
Med Leg J ; 85(4): 215-218, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29210337

RESUMO

Kounis syndrome, also known as allergic myocardial infarction or allergic angina syndrome, coincides with chest pain and allergic reactions. It involves the activation of interrelated inflammatory cells following allergic, anaphylactic or anaphylactoid insults. We report a case of Kounis syndrome complicated by an injection of ceftazidime. A 52-year-old man developed shortness of breath and hypotension, leading to immediate unconsciousness, after a ceftazidime injection. Despite intensive care management, he showed no improvement and died approximately 19 h after ceftazidime administration. Autopsy showed massive laryngeal oedema, mucous plugging and collapsed lungs. An ImmunoCAP tryptase assay showed the tryptase level in an autopsy sample to be 118 µg/L (normal < 11.4 µg/L). Microscopy of the myocardium showed cellular infiltration preceding myocardial necrosis. These findings support the pathophysiological theory of Kounis syndrome, with cellular infiltration proposed as the cause of myocardial injury rather than an effect related to the healing process.


Assuntos
Ceftazidima/efeitos adversos , Síndrome de Kounis/complicações , Síndrome de Kounis/etiologia , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Autopsia , Ceftazidima/uso terapêutico , Humanos , Síndrome de Kounis/fisiopatologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Punções/efeitos adversos
20.
J Med Case Rep ; 11(1): 145, 2017 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-28532437

RESUMO

BACKGROUND: Kounis syndrome corresponds to the occurrence of myocardial injury following an allergic insult. This syndrome is infrequent, and is not well known. In consequence, it is usually misdiagnosed leading to inappropriate treatment. The current literature is limited to case studies and there are no international recommendations concerning this topic. CASE PRESENTATION: We discussed, through two case reports, the clinical presentation and the management of a 60-year-old North African man and a 45-year-old North African man presenting with chest pain suggesting acute coronary syndrome following anaphylactic reaction. Triggering factors were a drug in the first case and herbal dermal exposure in the second. A clinical examination and electrocardiogram revealed anaphylactic reaction associated with myocardial infarction. Appropriate management of these two life-threatening conditions allowed an improvement in our patients' condition and their transfer to specialized units. CONCLUSIONS: Although Kounis syndrome is a rare phenomenon, physicians should be aware of its physiopathological mechanisms in order to treat it appropriately. The difficulty lies in the fact that the treatment of either of the two associated entities may worsen the other injury.


Assuntos
Amoxicilina/efeitos adversos , Anafilaxia/induzido quimicamente , Anti-Inflamatórios/efeitos adversos , Anticoagulantes/efeitos adversos , Dor no Peito/induzido quimicamente , Dexametasona/efeitos adversos , Síndrome de Kounis/diagnóstico , Amoxicilina/administração & dosagem , Anafilaxia/fisiopatologia , Anti-Inflamatórios/administração & dosagem , Anticoagulantes/administração & dosagem , Aspirina/uso terapêutico , Dor no Peito/fisiopatologia , Clopidogrel , Dexametasona/administração & dosagem , Eletrocardiografia , Guias como Assunto , Humanos , Síndrome de Kounis/tratamento farmacológico , Síndrome de Kounis/fisiopatologia , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/uso terapêutico , Ticlopidina/análogos & derivados , Ticlopidina/uso terapêutico , Resultado do Tratamento
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