Successful treatment of prolonged cardiopulmonary arrest of Kounis syndrome during coronary angioplasty

Akita, Tomomi; Kawata, Masahito; Sakaguchi, Ayu; Kato, Yoshio; Suehiro, Hideya; Tanaka, Hiroki; Matsuura, Takeshi; Kamemura, Kohei; Hirayama, Y.; Adachi, Kazumasa; Matsuura, Akira; Sakamoto, Susumu

doi:10.1016/j.jccase.2015.10.001

Cited by 6 publications

(1 citation statement)

References 8 publications

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“…However, it has favorable pharmacological features and is expected to be a useful drug. [10,29] Fortunately, in this case, the patient was diagnosed with Kounis syndrome based on ST-segment elevation in lead II on the bedside ECG monitor. The ST-segment elevation improved markedly upon administration of nicorandil and adrenaline.…”

Section: Discussionmentioning

confidence: 85%

Refractory cardiac arrest caused by type I Kounis syndrome treated with adrenaline and nicorandil: A case report

et al. 2023

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Rationale: Kounis syndrome is a rare but life-threatening anaphylactic reaction that can lead to acute coronary syndrome and cardiac arrest, and requires prompt diagnosis. Adrenaline, which is used to treat anaphylaxis, may cause coronary vasoconstriction and worsen ischemia, whereas coronary vasodilators may dilate systemic vessels and exacerbate hypotension. Delayed diagnosis of Kounis syndrome and inadequate therapeutic intervention may thus lead to a poor outcome. Patient concerns: A 59-year-old man was treated for sepsis due to a liver abscess. Following administration of daptomycin, the patient developed severe anaphylactic shock leading to refractory cardiac arrest. Because conventional cardiopulmonary resuscitation was ineffective, extracorporeal cardiopulmonary resuscitation was considered as an alternative approach. Diagnoses: On bedside monitoring during cardiopulmonary resuscitation, unexpected ST-segment elevation was found on lead II electrocardiogram. Accordingly, the patient was clinically diagnosed with Kounis syndrome. Interventions: Nicorandil (6 mg/h), a coronary vasodilator with minimal blood pressure effects, was administered along with high doses of vasopressors, including adrenaline 0.2 µg/kg/min. Outcomes: After the initiation of nicorandil administration, the patient achieved return of spontaneous circulation and did not require extracorporeal cardiopulmonary resuscitation. Based on the elevated serum tryptase level, normal creatine kinase-MB range, and lack of stenosis on coronary angiography, the patient was definitively diagnosed with type I (coronary vasospasm) Kounis syndrome. He was subsequently transferred to the referring hospital without neurological sequelae. Lessons: If anaphylaxis leads to refractory shock and cardiac arrest, ischemic changes on the electrocardiogram should be investigated to identify underlying Kounis syndrome. In addition to adrenaline, coronary dilators are the definitive treatment. Nicorandil may be a useful treatment option because of its minimal effect on blood pressure.

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Section: Discussionmentioning

confidence: 85%

Refractory cardiac arrest caused by type I Kounis syndrome treated with adrenaline and nicorandil: A case report

et al. 2023

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蜜蜂刺傷により冠動脈ステント血栓症が惹起されたKounis症候群III型の1例(A case of type III Kounis syndrome resulting from coronary artery stent thrombosis induced by a honeybee sting)

宣夫

和彦

博人

et al. 2019

Nihon Kyukyu Igakukai Zasshi: Japanese Journal of Japanese Asso

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要旨　Kounis症候群はアレルギー反応により，急性冠症候群（ACS）を起こす稀な疾患である。今回，我々は蜜蜂刺傷によるKounis症候群III型を経験したので報告する。症例は70歳の男性。3年前に急性前壁中隔心筋梗塞を発症し，左前下行枝，回旋枝に薬剤溶出ステントを留置されていた。今回，蜜蜂刺傷によるアナフィラキシーショックを発症し，近医にてアドレナリン投与されたが，低血圧が遷延したため当院に搬送された。その後，心電図の虚血性変化が顕性化したため，緊急冠動脈造影を施行。左前下行枝のステント内に血栓による完全閉塞を認めたため，緊急冠動脈インターベンションを施行，血流再開した。その後の治療では，intra–aortic balloon pumping（IABP）の施行，大量カテコラミン投与が必要で，集中治療室在室期間は12日間に及んだが，第34病日に無事退院した。各種抗原特異的IgE抗体価を測定した結果，蜜蜂に対する抗体価のみ陽性であった。以上より，蜜蜂刺傷によるアナフィラキシーショックからステント内血栓が惹起され，ACSを発症したKounis症候群III型と診断した。アレルギー反応，とくにアナフィラキシーショックが遷延する場合には，Kounis症候群の存在を常に念頭に置くことが必要である。

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2016

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Successful treatment of prolonged cardiopulmonary arrest of Kounis syndrome during coronary angioplasty

Cited by 6 publications

References 8 publications

Refractory cardiac arrest caused by type I Kounis syndrome treated with adrenaline and nicorandil: A case report

Refractory cardiac arrest caused by type I Kounis syndrome treated with adrenaline and nicorandil: A case report

蜜蜂刺傷により冠動脈ステント血栓症が惹起されたKounis症候群III型の1例(A case of type III Kounis syndrome resulting from coronary artery stent thrombosis induced by a honeybee sting)

Dextran

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