Kounis syndrome: Simply forgotten but never forgotten!

Tóm tắt

Background

Kounis syndrome (KS) was first described in 1999 by Kounis and Zavras. It is an acute coronary syndrome with a hypersensitivity reaction. It was also called "allergic angina." Allergic myocardial infarction occurs when allergic angina becomes acute. Mast cells are mostly found in artery intima and myocardial fibres in the heart. Mast cells abound in atherosclerotic plaques. Mast cell activation causes KS coronary artery vasospasm and atheromatous plaque erosion or rupture. 

Methods

There are three variants of KS (1, 2). In type I, allergic reactions cause coronary artery spasm in patients with normal or nearly normal arteries. Troponins and cardiac enzymes may be elevated. Microvascular angina and endothelial dysfunction may be involved. Type II includes atherosclerotic patients. Acute allergic reactions cause plaque erosion or rupture, resulting in acute myocardial infarction in symptomatic or quiescent patients. Type III includes allergic coronary artery stent thrombosis. 

Results

We reported type 1 KS. A 60-year-old man with no known cardiovascular risk factors or allergies was bitten by insects on the scalp and right wrist. Five minutes later, he had dizziness, chest discomfort, and syncope. He regained consciousness at the hospital. The ECG showed ST elevation in leads II, III, and aVF and ST depression in leads I and aVL. Hydrocortisone and parenteral anticoagulation were administered. There were no dynamic ECG changes or elevated cardiac biomarkers. He had mild coronary artery disease and a normal echocardiogram. The diagnosis of vasospastic angina was made secondary to an insect bite. He was well discharged. 

Conclusion

It is essential to recognize these types of KS in order to provide appropriate care and management. The diagnosis and management of KS can be rather difficult, requiring concurrent attention to cardiac and anaphylactic pathogenesis. The major focus of treatment for KS should be on addressing the allergic insult and removing the offending allergens. Thus, patients admitted with chest pain and electrocardiographic abnormalities should be interrogated for any history of recent exposure to any allergic insult, especially those with an underlying allergy, who should be evaluated for a more probable diagnosis of Kounis syndrome.