scholarly journals Allergy Associated Myocardial Infarction: A Comprehensive Report of Clinical Presentation, Diagnosis and Management of Kounis Syndrome

Vaccines ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 38
Author(s):  
Anastasios Roumeliotis ◽  
Periklis Davlouros ◽  
Maria Anastasopoulou ◽  
Grigorios Tsigkas ◽  
Ioanna Koniari ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Arteries ◽  
Case Reports ◽  
Type I ◽  
Type Ii ◽  
Kounis Syndrome ◽  
Normal Coronary Arteries ◽  
St Segment Elevation ◽  
Type Iii ◽  
Coronary Syndrome

Kounis syndrome (KS) has been defined as acute coronary syndrome (ACS) in the context of a hypersensitivity reaction. Patients may present with normal coronary arteries (Type I), established coronary artery disease (Type II) or in-stent thrombosis and restenosis (Type III). We searched PubMed until 1 January 2020 for KS case reports. Patients with age <18 years, non-coronary vascular manifestations or without an established diagnosis were excluded. Information regarding patient demographics, medical history, presentation, allergic reaction trigger, angiography, laboratory values and management were extracted from every report. The data were pulled in a combined dataset. From 288 patients with KS, 57.6% had Type I, 24.7% Type II and 6.6% Type III, while 11.1% could not be classified. The mean age was 54.1 years and 70.6% were male. Most presented with a combination of cardiac and allergic symptoms, with medication being the most common trigger. Electrocardiographically, 75.1% had ST segment elevation with only 3.3% demonstrating no abnormalities. Coronary imaging was available in 84.8% of the patients, showing occlusive lesions (32.5%), vascular spasm (16.2%) or normal coronary arteries (51.3%). Revascularization was pursued in 29.4% of the cases. In conclusion, allergic reactions may be complicated by ACS. KS should be considered in the differential diagnosis of myocardial infarction with non-obstructive coronary arteries.

Abstract 16404: Allergy Associated Myocardial Infarction: A Comprehensive Review of Clinical Presentation, Diagnosis and Management of Kounis Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Anastasios Roumeliotis ◽  
Periklis Davlouros ◽  
Maria Anastasopoulou ◽  
Grigorios Tsigkas ◽  
Georgios Hahalis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Clinical Presentation ◽  
Type I ◽  
Type Ii ◽  
Kounis Syndrome ◽  
Normal Coronary Arteries ◽  
Type Iii ◽  
Coronary Syndrome

Introduction: Kounis syndrome (KS) is defined as acute coronary syndrome (ACS) in the context of a hypersensitivity reaction. Patients may present with normal coronary arteries (Type I), established coronary artery disease (Type II) or in-stent thrombosis and restenosis (Type III). Hypothesis: We sought to investigate the clinical presentation, underlying pathophysiology, diagnosis and medical management of patients with KS. Methods: We searched PubMed until 1/1/2020 for case reports of KS. Patients with age <18 years, non-coronary vascular manifestations and without an established KS diagnosis were excluded. Information regarding patient demographics, medical history, clinical presentation, allergic reaction trigger, angiographic results as well as management were manually extracted from every report. All data were pulled in a combined data set and descriptive statistics were analyzed. Results: Out of the 269 unique patients with KS, 157 (58.4%) had Type I, 64 (23.8%) Type II and 18 (6.7%) Type III while 30 (11.2%) could not be classified. Their mean age was 54.1 years and 190 (70.6%) were male. The majority presented with a combination of cardiac and allergic symptoms [Panel A] and medication was the most commonly reported trigger [Panel B]. Electrocardiographically, 75.1% of cases had ST segment elevation with only 3.3% demonstrating no abnormalities. Coronary imaging was available in 228 (84.8%) patients showing occlusive lesions (32.5%), vascular spasm (16.2%), or normal coronary arteries (51.3%). Percutaneous coronary intervention or coronary artery bypass grafting was performed in 70 (29.4%) of the 238 patients with available information. Conclusions: Hypersensitivity induced ACS is most frequently triggered by medications, and the majority of patients have patent coronary arteries suggesting microvascular dysfunction. KS should be considered in the differential diagnosis of myocardial infarction with non-obstructive coronary arteries.

scholarly journals Kounis syndrome uncovers severe coronary disease: an unusual case of acute coronary syndrome secondary to allergic coronary vasospasm

2019 ◽  
Vol 12 (12) ◽  
pp. e232472
Author(s):  
Luca Conti ◽  
Kelly Gatt ◽  
Christopher Zammit ◽  
Karen Cassar
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
High Signal ◽  
Type I ◽  
Kounis Syndrome ◽  
Coronary Syndrome ◽  
Triple Vessel Disease ◽  
Appropriate Treatment ◽  
St Elevation ◽  
Type I Hypersensitivity

Acute coronary syndrome occurring during the course of a type I hypersensitivity reaction constitutes Kounis syndrome. We report a case of a 64-year-old man who presented with a non-ST elevation myocardial infarction and peripheral blood eosinophilia. He had rhinitis and constitutional symptoms for several days prior to presentation. Blood investigations revealed moderate eosinophilia and elevated IgE levels. A cardiac MRI showed generalised oedema with a subtle wall motion abnormality in basal inferior/inferolateral wall, and subendocardial high signal on late gadolinium enhancement suggesting a localised myocardial infarction. A coronary angiogram then revealed triple vessel disease. A diagnosis of Kounis syndrome was made. Within days of starting appropriate treatment, the patient’s eosinophil count returned to normal with improvement of clinical picture.

Survival After Neonatal Myocardial Infarction

PEDIATRICS ◽  
1991 ◽  
Vol 88 (1) ◽  
pp. 145-150
Author(s):  
JOHN BOULTON ◽  
RICHARD HENRY ◽  
LAURENCE G. RODDICK ◽  
DAVID ROGERS ◽  
LINDA THOMPSON ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Arteries ◽  
Neonatal Period ◽  
Case Reports ◽  
Normal Coronary Arteries ◽  
The Third ◽  
Early Neonatal Period

These are case reports of two children with structurally normal hearts and with normal coronary arteries, who survived myocardial infarction in the early neonatal period. They are only the third and fourth reported survivors of neonatal myocandial infarction and the first in which hypercholesterolemia is postulated to have played an important role. The most likely cause of the myocardial infarction was thrombosis or thromboembolism. Changes in hemostatic function associated with hypencholesterolemia may be relevant.

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.

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