Kounis syndrome

Abstract

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).Today, allergic angina and allergic myocardial infarction are referred to as KS, and the latter has been reported in association with a variety of drugs, insect stings, food, environmental exposures and medical conditions, among other factors.The incidence is not known, as most of the available information comes from case reports or small case series. In this article, the clinical aspects, diagnosis, pathogenesis, related conditions and therapeutic management of the syndrome are discussed. Síndrome de KounisResumen El síndrome de Kounis (SK) fue descrito en 1991 por Kounis y Zavras como la aparición simultánea de eventos coronarios agudos y reacciones alérgicas anafilácticas o anafilactoides. Engloba conceptos como el de angina alérgica e infarto alérgico y se ha descrito en relación con picaduras de insectos, ingesta de fármacos y alimentos, exposiciones ambientales y condiciones médicas varias. Se desconoce su incidencia real ya que, la mayoría de lainformación proviene de casos clínicos o pequeñas series.En el presente artículo se exponen los aspectos clínicos, diagnósticos, fisiopatología y tratamiento de este síndrome.

Kounis Syndrome – Report of 4 cases

“…The allergic reaction induces coronary spasm, resulting in chest pain and/or ECG changes secondary to ischemia (however, sometimes the ECG can be normal, as in our patient 2). Cardiac enzymes may be either increased (as in our patients 2 and 4) or normal 6 (as in our patients 1 and 3); -Type II (patients with coronary disease): it presents with chest pain during a hypersensitivity reaction in patients with preexisting coronary disease, such as atherosclerosis. It has been proposed that the release of inflammatory mediators induces plaque erosion or rupture, resulting in cardiac ischemia.…”

“…It has been proposed that the release of inflammatory mediators induces plaque erosion or rupture, resulting in cardiac ischemia. ECG and cardiac enzymes may either be normal or show changes compatible with cardiac ischemia 6 ;…”

“…Allergens induce mast cell degranulation, which leads to local and systemic secretion of vasoactive mediators (histamine, leukotrienes) with coronary vasoconstrictor effect and of proteases (tryptase) capable of activating metalloproteinases with collagen degradation and erosion of the atherosclerotic plaque, thus resulting in cardiac ischemia. 6 KS is often underdiagnosed. 3 The diagnosis is essentially clinical, but it may also be based on laboratory, ECG, and echocardiographic abnormalities or on abnormal coronary angiography (except for type I KS).…”

“…Echocardiogram and coronary angiography can show absence/presence of cardiac wall-motion abnormalities and characterize normal/abnormal coronary arteries, thus allowing to diagnose type I or II/III KS. 3,4,6 There are no specific treatment guidelines, and the recommendations are based on cases reported in the literature. 8 Both the allergic reaction and myocardial ischemia must be treated.…”

Kounis Syndrome - a Natural Paradigm

“…2. Type II (with coronary disease): chest pain in patients with culprit, pre-existing atheroma disease; the release of inflammatory mediators induces coronary artery spasm with normal cardiac enzymes, or coronary artery spasm with plaque rupture, resulting in acute myocardial infarction [23], [24].…”