The recent understanding of kounis syndrome has led to the classification of this condition into three syndrome variants. A case of possible kounis syndrome as a complication of. The chances of kounis syndrome or acute coronary syndrome acs can not be denied in this patient, however the priority is to save the life of the patient first in this emergency situation. Kounis syndrome is defined as the concurrence of acute coronary syndromes with conditions associated with mast cellactivation, involving interrelated and interacting inflammatory cells, and includes allergic or hypersensitive and anaphylactic or anaphylactoid reactions. Kounis syndrome is a rare anaphylactic reaction leading to coronary spasm, acute plaque rupture, or intrastent stenosis. We report the case of 57yearold man, with hypertension and history of allergy, referred for facial rash and palpitations appeared after consumption of canned tuna fish. Unusual cause and presentation of collapsing focal segmental glomerulosclerosis. Kounis syndrome represents the concurrence of acute coronary syndromes or anginal pain with allergic, hypersensitivity, and anaphylactic reactions. Kounis syndrome ks is the concurrence of acute coronary syndrome associated with mastcell and platelet activation in the setting of hypersensitivity and allergic or anaphylactic insults.
In this patient there is a rare combination of mushroom poisoning syndrome coprinic syndrome and kounis syndrome. Diagnostics free fulltext contrast media induced kounis. Kounis syndrome ks is a hypersensitivity coronary disorder induced by various allergens. This syndrome is infrequent, and is not well known. Findings from the federally funded womens ischemia syndrome evaluation wise study a landmark investigation into ischemic heart disease meaning reduced blood supply to the heart muscle are helping us to understand that, as the harvard womens health watch puts it. Rocuroniuminduced coronary vasospasm kounis syndrome. Type 1 kounis syndrome in patient with idiopathic anaphylaxis.
Idiopathic anaphylaxis is defined as anaphylaxis without any identifiable precipitating agent or event. We present a case of male who experienced attacks of. Acute coronary syndrome accompanying mast cell activation from allergic, hypersensitivity, or anaphylactoid reactions was first described by kounis and zavras in 1991 and has been referred to as allergic angina or allergic myocardial infarction 1, 2. The most likely cause is kounis syndrome ks, a hypersensitivity coronary disorder induced by exposure to drugs, foods, and other triggers. Coronary arteriography revealed coronary vasospasm in coronary arteries otherwise free of disease. Kounis syndrome in south africa sa have ever been reported in the literature. Kounis syndrome is concurrence of acute coronary syndromes with conditions associated with mast cell activation, such as allergies or hypersensitivity and anaphylactic or anaphylactoid insults 88 r, 89 r. In the icu, the patient was again administered rocuronium for a procedure with subsequent hypotension, bradycardia, and st elevation on telemetry that resolved with administration of diphenhydramine and hydrocortisone. Professor nicholas g kounis, cardiologist from greece was the first to observe and take a previously underrated, scattered and rarely diagnosed, clinical phenomena, described the pathophysiology and introduced in 1991, for the first time in the world medical literature, the term. The mechanism of ks consists in the release of inflammatory cytokines through mast cell activation, causing cardiac anaphylaxis with coronary artery vasospasms.
Most of the information about this syndrome has come from the case reports. His history is signi ficant because of exerciseinduced. Kounis syndrome ks is a complex of cardiovascular symptoms and signs following either allergy or hypersensitivity and anaphylactic or anaphylactoid insults. Several cases of kounis syndrome in patients with samters triad have been reported. Controlled trials will never be done given the complexity of the presentation. Most of the information on this syndrome comes from case reports or small case series. This is the first reported case of an intraoperative kounis syndrome as the onset of an indolent systemic mastocytosis probably triggered by succinylated gelatin infusion during general. The mechanism of kounis syndrome ks involves release of inflammatory cytokines through mast cell activation, which leads to.
Acute coronary syndrome secondary to allergic coronary. However, it was not until 1991 when kounis and zavras described the allergic angina syndrome as coronary spasm progressed to allergic acute mi 3. There are few published reports that have shown an association between lidocaine and kounis syndrome. We searched medline through march 31, 2016 for reports of ks. Drs koutsojannis and kounis suggest that the fatal anaphylactic reactions associated with lepirudin reexposure are typical examples of allergic acute coronary syndrome acs. Jan 26, 20 kounis syndrome is characterized by a group of symptoms that manifest as unstable vasospastic or nonvasospastic angina secondary to a hypersensitivity reaction. Nicholas kounis in 1991 coining it allergic angina.
In consequence, it is usually misdiagnosed leading to inappropriate treatment. Kounis syndrome is defined as an acute coronary syndrome triggered by the release of inflammatory mediators following an allergic insult characterized by acute onset of breathlessness, palpitations, diaphoresis and chest tightness gazquez v, dalmau g, gaig p, gomez c, navarro s, merce j. Electrocardiographic changes after overdose of epinephrine in. Arachidonic acid metabolites such as leukotrienes and thromboxane. A 49yearold male became hypotensive, bradycardic, and suffered myocardial injury during induction of anesthesia with lidocaine, propofol, and rocuronium in the operating room.
Kounis syndrome ks is characterized by a concurrent occurrence of acute coronary syndromes with conditions associated with mast cell activation including allergic or hypersensitivity and anaphylactic or anaphylactoid insults. Kounis syndrome is defined as acute coronary syndrome caused by an allergic reaction or a strong immune reaction to a drug or any other substance. Kounis syndrome seems to be a complex acute coronary syndrome that requires early diagnosis, followed by immediate and rapid treatment. Electrocardiographic changes after overdose of epinephrine. Kounis syndrome is the concurrence of acute coronary syndromes with mast cells activation induced by hypersensitivity and anaphylactoid insults and is increasingly encountered in clinical practice.
Kounis syndrome following canned tuna fish ingestion. Although the beneficial attributes and application of protamine sulfate in various clinical settings cannot be argued, it also has an impressive sideeffect profile. Type i occurs in patients without risk factors and normal coronary arteries, hence acute release of. My questions, which i intend to ask a doctor, have to do with being. Kounis syndrome ks was described in 1991 by kounis and zavras as the coincidental occurrence of acute coronary syndromes acss with allergic reactions anaphylactic or anaphylactoid. Cureus kounis syndrome induced by protamine sulfate. Kounis syndrome is defined as the coincidental occurrence of an acute coronary syndrome with hypersensitivity reactions following an allergenic event and was first described by kounis and zavras. Kounis syndrome an atopic monster for the heart allergic reactions to chemicals, food products or even insect bites are encountered all over the world with a variety of manifestations. A hypersensitivity blow up inside the coronaries 2. In the case presented here, dlst revealed that the 1 % lidocaine used for local anesthesia was the cause of kounis syndrome.
Symptoms range from the development of a minor rash to life threatening anaphylactic reactions. Many types of medicine or environmental factors can potentially trigger kounis syndrome by mast cell allergic reactions. Kounis syndrome is defined as the concurrence of acute coronary syndromes such as coronary spasm or acute myocardial infarction with conditions associated with activation of inflammatory mediators such histamine, arachidonic acid and various cytokines and chemokines. The current literature is limited to case studies and there are no international recommendations concerning this topic. Type i includes patients with normal coronary arteries and without. It can be associated with normal coronary angiogram or preexistent coronary pathology. Protamine sulfate is considered a lifesaving antidote for heparinized patients with major bleeds. When anaphylactic or anaphylactoid and allergic or hypersensitivity reactions from causes such as insect stings, drugs and other environmental exposures combine with cardiovascular signs and symptoms, acute coronary events and stent thrombosis with thrombus infiltrated by eosinophils andor mast cells, the result is the kounis hypersensitivity associated syndrome. When there is a young individual with no predisposing factors for atherosclerosis, and an apparent coronary lesion, with or without ecg and biochemical markers of infarction, the possibility of kounis syndrome should always be. Abstract 3 impact of ccta on ed efficiency and downstream testing 5.
Application of oral lactulose in combination with polyethylene glycol electrolyte powder for colonoscopy bowel preparation in patients with constipation. Sep 03, 2010 kounis syndrome is a complex acute coronary syndrome which requires rapid treatment decisions. Lepirudin anaphylaxis and kounis syndrome circulation. Stent dislodgement induced by a vasodilator used for.
Posts about kounis syndrome written by carolyn thomas. Mycophenolateinduced posterior reversible encephalopathy syndrome. Theoharides and kounis article explains a lot about kounis syndrome and allergic heart attacks. The management of these patients may be challenging for clinicians, and unfortunately guidelines have not been established yet. Although there is no doubt that the cardiac events occurring in the lepirudintreated patients are associated with an immune reaction, their clinical course differs from. Apr 30, 2015 in this patient there is a rare combination of mushroom poisoning syndrome coprinic syndrome and kounis syndrome. Kounis syndrome is characterized by a group of symptoms that manifest as unstable vasospastic or nonvasospastic angina secondary to a hypersensitivity reaction. Since then this condition has evolved to include a number of mast cell activation disorders. Kounis syndrome medicina intensiva english edition. Stent dislodgement induced by a vasodilator used for severe. Kounis syndrome ks is an acute coronary syndrome in the setting of an allergic reaction, which can be induced by numerous. Many drugs and environmental exposures had been reported as inducers, but various inducers and the mechanism of ks remained unknown till now. Kounis syndrome is defined as the concurrence of acute coronary syndromes acss such as coronary spasm, acute myocardial infarction, and stent thrombosis, with conditions associated with mastcell and platelet activation involving interrelated and interacting inflammatory cells in the setting of allergic or hypersensitivity and anaphylactic or anaphylactoid insults.
Kounis syndrome, acute coronary syndrome, anaphylaxis, management, case report background kounis syndrome ks is defined as the occurrence of an acute coronary syndrome acs concomitantly with hypersensitivity reactions triggered by an allergenic event and was first described by kounis and zavrasin in 1991 as an allergic angina. Kounis syndrome is defined as acute coronary syndrome symptoms such as chest pain relating to reduced blood flow to the heart caused by an allergic reaction or a strong immune reaction to a drug or other substance. Makoto hasegawa, tatsuya gomi, in side effects of drugs annual, 2015. The kounis syndrome was described 15 years ago as the concurrence of acute coronary events with allergic or hypersensitivity reactions as well as anaphylactic or anaphylactoid insults.
This syndrome was first described and therefore named after dr. The widely used traditional chinese medicine tcm as. Allergic reactions following implantation of drugeluting. My questions, which i intend to ask a doctor, have to do with being hypertensive during a mast cell degranulation. The main pathophysiological mechanism is vasospasm of the epicardial coronary arteries due to increased inflammatory mediators that are released during a hypersensitivity reaction. It was first described in 1991 by kounis and zavras 1 as the syndrome of allergic angina due to coronary artery spasm provoked by the release of histamine. In 1991, kounis and zavras described the syndrome of allergic angina and allergic myocardial infarction, currently known as kounis syndrome ks.
Aug 15, 2012 posts about kounis syndrome written by carolyn thomas. Kounis syndrome is defined as the concurrence of acute coronary syndromes with mast cell activation in a setting of allergic or hypersensitivity reactions. Instent restenosis and thrombosis due to metal hypersensitivity. Allergic angina and allergic myocardial infarction. After treatment of the acute shock and coronary event, a full cardiology workup, including electrocardiograms and echocardiogram, along with cardiac risk factor modification, are necessary. The widely used traditional chinese medicine tcm as a. In severe kounis syndrome, reduced blood pressure or cardiac arrest may be accompanying symptoms. This is a rare case of kounis syndrome, caused by a lidocaine allergy, which occurred during a pci procedure.
Kounis syndrome allergic reaction global coronary artery syndrome 0 rating rating ratings. May 07, 2020 kounis syndrome cases, although under reported, are more often encountered in clinical practice and it is anticipated that many more causative factors will be implicated in the future. Successful treatment of kounis syndrome type i presenting. The treatment strategy for kounis syndrome is usually. Oct 01, 2015 kounis syndrome is characterised by a group of symptoms that manifest as unstable vasospastic or nonvasospastic angina secondary to a hypersensitivity reaction. Kounis syndrome is potentially a lifethreatening medical emergency with both a severe allergic reaction and acute coronary syndrome. In kounis syndrome, nitroglycerin can worsen hypotension. It is a rare condition which has been reported in every age group 290 years, every race and geographic. Mast cell activation and release of inflammatory cytokines from the reaction leads to spasm. Kounis syndrome cases, although under reported, are more often encountered in clinical practice and it is anticipated that many more causative factors will be implicated in the future. Kounis syndrome secondary to amoxicillinclavulanic acid. Kounis syndrome is characterised by a group of symptoms that manifest as unstable vasospastic or nonvasospastic angina secondary to a hypersensitivity reaction. Abstract 2 pitfalls of ecg in low risk chest pain 6.