Letter to the Editor: Anaphylactic Cardiovascular Collapse during Anesthesia: The Kounis Acute Hypersensitivity Syndrome Seems to be the Most Likely Cause

Kounis, Nicholas G.; Kounis, George N.

doi:10.3346/jkms.2013.28.4.638

Cited by 8 publications

(9 citation statements)

References 14 publications

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“…However, these three agents have been incriminated as inducing mild or severe hypersensitivity reactions. [ 2 ] Clinical studies have shown that patients, prone to allergy, have more symptoms than monosensitized individuals when simultaneously exposed to several anesthetics, as in the described case. This is based on findings that subthreshold numbers of immunoglobulin E antibodies with different specificities may have additive effects and can join forces to trigger mast cells to release their mediators.…”

mentioning

confidence: 76%

Allergic Angina Syndrome in Anesthesia and Diabetes

Kounis

Koniari

Tzanis

et al. 2018

Indian Journal of Critical Care Medicine

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mentioning

confidence: 76%

Allergic Angina Syndrome in Anesthesia and Diabetes

Kounis

Koniari

Tzanis

et al. 2018

Indian Journal of Critical Care Medicine

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“…Differentiating myocardial tissue hypoperfusion caused by systemic vasodilation, plasma leakage due to vascular permeability leading to volume loss and reduced venous return from primary myocardial tissue damage and dysfunction due to coronary vasoconstriction and thrombosis induced by released anaphylactic mediators' action (histamine, chymase, tryptase, cathepsin D, leukotrienes, thromboxane, platelet activating factor), remains seemingly challenging (94). In anaphylactic cardiovascular collapse, myocardial involvement due to vasospasm-induced coronary blood flow reduction manifesting as Kounis syndrome should be always considered (95). Clinically, combined treatment targeting the primary cause of anaphylaxis together with protection of cardiac tissue seems to be of paramount importance (96).…”

Section: Discussionmentioning

confidence: 99%

Anaphylactic cardiovascular collapse and Kounis syndrome: systemic vasodilation or coronary vasoconstriction?

et al. 2018

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The first reported human anaphylactic death is considered to be the Pharaoh Menes death, caused by a wasp sting. Currently, anaphylactic cardiovascular events represent one of most frequent medical emergencies. Rapid diagnosis, prompt and appropriate treatment can be life saving. The main concept beyond anaphylaxis lies to myocardial damage and ventricular dysfunction, thus resulting in cardiovascular collapse. Cardiac output depression due to coronary hypoperfusion from systemic vasodilation, leakage of plasma and volume loss due to increased vascular permeability, as well as reduced venous return, are regarded as the main causes of cardiovascular collapse. Clinical reports and experiments indicate that the human heart, in general, and the coronary arteries, in particular, could be the primary target of the released anaphylactic mediators. Coronary vasoconstriction and thrombosis induced by the released mediators namely histamine, chymase, tryptase, cathepsin D, leukotrienes, thromboxane and platelet activating factor (PAF) can result to further myocardial damage and anaphylaxis associated acute coronary syndrome, the socalled Kounis syndrome. Kounis syndrome with increase of cardiac troponin and other cardiac biomarkers, can progress to heart failure and cardiovascular collapse. In experimental anaphylaxis, cardiac reactions caused by the intracardiac histamine and release of other anaphylactic mediators are followed by secondary cardiovascular reactions, such as cardiac arrhythmias, atrioventricular block, acute myocardial ischemia, decrease in coronary blood flow and cardiac output, cerebral blood flow, left ventricular developed pressure (LVdp/dtmax) as well as increase in portal venous and coronary vascular resistance denoting vascular spasm. Clinically, some patients with anaphylactic myocardial infarction respond satisfactorily to appropriate interventional and medical therapy, while anti-allergic treatment with antihistamines, corticosteroids and fluid replacement might be ineffective. Therefore, differentiating the decrease of cardiac output due to myocardial tissue hypoperfusion from systemic vasodilation and leakage of plasma, from myocardial tissue due to coronary vasoconstriction and thrombosis might be challenging during anaphylactic cardiac collapse. Combined antiallergic, anti-ischemic and antithrombotic treatment seems currently beneficial. Simultaneous measurements of peripheral arterial resistance and coronary blood flow with newer diagnostic techniques including cardiac magnetic resonance imaging (MRI) and myocardial scintigraphy may help elucidating the pathophysiology of anaphylactic cardiovascular collapse, thus rendering treatment more rapid and effective.

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“…1 Há registo de hipersensibilidade, anafilaxia e morte pela administração de sulfitos. 8 Embora a SK esteja descrita maioritariamente em adultos surgiram, recentemente, novos casos na população pediátrica. 6 Para o seu diagnóstico é necessário um alto índice de suspeição.…”

Section: Discussionunclassified

Abordagem Anestésica na Síndrome de Kounis - Um Inimigo Cardíaco Pouco Conhecido: A Propósito de um Caso Clínico

Gonçalves

Caridade

Gomes

2018

Gaz Med

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A síndrome de Kounis, também conhecida como síndrome da angina alérgica, foi descrita em 1991 por Kounis e Zafras como a "ocorrência coincidente de dor torácica e reação alérgica acompanhadas de achados clínicos e laboratoriais de angina pectoris clássica, causada por mediadores inflamatórios libertados durante o estímulo alérgico".Os autores apresentam o caso de um doente de 57 anos, diagnosticado com síndrome de Kounis, submetido a polipectomia nasal, meatotomia média e etmoidectomia ântero-posterior. Com esta publicação pretende-se fazer uma revisão teórica acerca da abordagem anestésica direcionada para esta síndrome dado que se trata de um tema recente, pouco conhecido e com envolvimento multidisciplinar (Anestesiologia, Cardiologia e Medicina Intensiva).

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Letter to the Editor: Anaphylactic Cardiovascular Collapse during Anesthesia: The Kounis Acute Hypersensitivity Syndrome Seems to be the Most Likely Cause

Cited by 8 publications

References 14 publications

Allergic Angina Syndrome in Anesthesia and Diabetes

Allergic Angina Syndrome in Anesthesia and Diabetes

Anaphylactic cardiovascular collapse and Kounis syndrome: systemic vasodilation or coronary vasoconstriction?

Abordagem Anestésica na Síndrome de Kounis - Um Inimigo Cardíaco Pouco Conhecido: A Propósito de um Caso Clínico

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