Myocardial bridge as a trigger of Kounis syndrome

Venturini, Elio; Marabotti, C; Magni, Lucia; Testa, Roberto; Kounis, Nicholas G.

doi:10.1016/j.ijcard.2015.08.154

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…11 Traditional coronary risk factors can further worsen the atherosclerotic burden in patients with myocardial bridging. 9 Despite the low coronary risk profile of our patient, the accumulation of mast cells at the proximal segment of the LAD induced myocardial damage. Functional and anatomical alterations of the coronary vessel induced by myocardial bridging can lead to vasospasm at the mid-LAD.…”

Section: Discussionmentioning

confidence: 65%

“…They are noted to be present in artherosclerotic lesions during acute coronary syndrome triggered by allergic reaction as well as in normal coronary arteries during vasospasms. 9 Cardiac mast cells respond to not only IgE-mediated stimuli but can also be activated by radiocontrast media. They release chymase and renin upon liberation which further activates the renin-angiotensin system and promotes local secretion of noradrenaline with subsequent stimulation of the adrenergic system.…”

Section: Discussionmentioning

confidence: 99%

“…There have been two reported cases of the type I variant of Kounis syndrome leading to myocardial infarction in the setting of myocardial bridging. 9,12 Hence, it can be concluded that a patient with myocardial bridging presents with a more severe presentation of Kounis syndrome.…”

Section: Discussionmentioning

confidence: 99%

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The Unusual Suspect: Gadobenate-Dimeglumine Induced Kounis Syndrome

Choudhry

Fackler

Patel

et al. 2019

Spartan Medical Research Journal

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A myocardial bridge has traditionally been considered a benign condition characterized by an atypical intramyocardial route of a segment of one of the major coronary arteries. However, the clinical complications of myocardial bridges can be dangerous. These potential complications include acute coronary syndromes, arrhythmias, ventricular dysfunction, and sudden death. Myocardial bridges are suspected to be adjuvant of Kounis syndrome, which is defined as an acute coronary syndrome caused by an allergic reaction. Due to high epidemiologic prevalence, clinical suspicion of a myocardial bridge should be considered in atypical and typical presentations of chest pain, especially in patients with low-risk factors for atherosclerotic disease. A male in their late 30's presented with non-ST elevation myocardial infarction suspected to be secondary to Kounis syndrome after gadobenate dimeglumine contrast media was used for an imaging study. His clinical presentation was further complicated when he was found to have a mid-left anterior descending coronary artery myocardial bridge.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Unusual Suspect: Gadobenate-Dimeglumine Induced Kounis Syndrome

Choudhry

Fackler

Patel

et al. 2019

Spartan Medical Research Journal

View full text Add to dashboard Cite

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“…In patients with the type I variant, treatment of allergy alone eliminates symptoms. For type II and III kounis syndrome, antiallergic therapy is as important as revascularization ( 10 ). Vasodilators such as calcium channel blockers and nitrates can be used to eliminate anaphylactogenic vasospasm ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Kounis syndrome due to cryptopteran bite

Liao,

Cheng,

2024

Front. Cardiovasc. Med.

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BackgroundKounis syndrome is an acute coronary syndrome (ACS) caused by allergic reactions, including coronary artery spasm (type I) caused by allergies without coronary predisposing factors, pre-existing coronary atherosclerosis, and coronary artery disease. Anaphylaxis leads to plaque rupture or erosion leading to acute myocardial infarction (type II) and acute coronary stent thrombosis (type III). Here we share a case of Kounis syndrome type I caused by an allergy caused by a Cryptopteran bite.Case presentationA 47-year-old woman was admitted to the hospital due to an insect bite for 2 days and chest distress for more than 3 h. Outside the hospital, electrocardiogram(ECG) showed sinus rhythm, ST-segment elevation in leads V1–V3, high-sensitivity troponin 2.54 ng/ml(0–0.5 ng/ml). One hour later, the ECG of the patient showed that the ST segment elevation of lead V1–V4 was 0.10–0.20 mV. Emergency coronary angiography showed coronary spasm and moderate lumen stenosis in the middle segment of left anterior descending artery (LAD). After treatment, the patient's symptoms were relieved, and the ST segment of lead V1–V4 of electrocardiogram returned to normal.ConclusionKunis syndrome is a life-threatening condition that can also cause myocardial ischemic injury in patients with or without coronary artery disease. Timely identification and anti-allergic treatment can achieve a good prognosis.

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“…The most frequent triggers for Kounis syndrome are drugs (metamizole [13], beta-lactam antibiotics: ampicillin-sulbactam [13][14][15], penicillin [2], cefuroxime [16][17][18], and other antibiotics, such as fluoroquinolones-levofloxacin [19]), contrast agents (gadolinium derivates [20,21]), insect venoms and snake venoms (Hymenoptera, cobra [22][23][24][25]), certain foods (tuna fish [26]), and proteins present in the natural latex [11]. Additionally, predisposing medical conditions, such as myocardial bridge (MB) [27], and atopic conditions have been described. The exact importance of triggers vs. preexistent pathology in driving Kounis syndrome remains to be established.…”

Section: Introductionmentioning

confidence: 99%

Type I Kounis Syndrome after Protracted Anaphylaxis and Myocardial Bridge—Brief Literature Review and Case Report

et al. 2020

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The term allergic angina, introduced for the first time by Nicholas Kounis in 1991, initially referred to the coexistence of acute coronary syndromes with allergy or hypersensitivity. At present, it is believed that Kounis syndrome is a particular case of systemic disease, with multiorgan arterial involvement generated during immediate hypersensitivity reactions. Myocardial bridging (MB), a condition that can induce coronary artery spasm, has long been regarded as a benign condition. Since both pathologies are associated with arterial spasm, Kounis syndrome and MB are considered to be confounding pathologies for acute coronary syndromes, and their association is quite a rare finding. To date, there are no precise data on the epidemiology, and the population affected by Kounis syndrome seems to be highly heterogeneous. Since this is a rare disease, even less is known about possible different phenotypes, including MB overlap. We report a case of type I variant Kounis syndrome associated with MB with no evidence of coronary artery disease, occurring as late presentation, following a severe systemic reaction (anaphylaxis) induced by a Hymenoptera sting. At present, only two other cases of type I and one case of type II Kounis syndrome occurring in patients with myocardial bridging have been described.

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Myocardial bridge as a trigger of Kounis syndrome

Cited by 5 publications

References 10 publications

The Unusual Suspect: Gadobenate-Dimeglumine Induced Kounis Syndrome

The Unusual Suspect: Gadobenate-Dimeglumine Induced Kounis Syndrome

Case Report: Kounis syndrome due to cryptopteran bite

Type I Kounis Syndrome after Protracted Anaphylaxis and Myocardial Bridge—Brief Literature Review and Case Report

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