Sign-in (or register) to check out the new features we've just launched!

Possible Causes For Kounis syndrome/Allergic Coronary Spasm - Causes

Ads

List of current finding(s):

Allergic, Collagen, Auto-Immune Disorders
Atopic allergic diseases
Drug allergy
Anaphylaxis, generalized
Bee/wasp venom allergy
Angioedema/Angioneurotic edema
Food allergy
Urticaria/Hives
Myocarditis, hypersensitivity/allergy
Functional, Physiologic Variant Disorders
Stress/Emotional/Physical
Reference to Organ System
Mastocytosis, systemic
Drugs
Lepirudin (Refluden) Administration/Toxicity
Streptokinase (Streptase) Administration/Toxicity
Urokinase (Abbokinase) Administration/Toxicity
Definition

Mast cell degranulation (atopic, stress or infection trigger) causing coronary spasm event; this is one primary theory for stress induced sudden death seen

with acute anaphylaxis and includes some drug induced events.

Kounis syndrome: the hypersensitivity coronary syndrome. What is?

“The concurrence of acute coronary syndromes with conditions associated with mast cell activation, involving interrelated and interacting inflammatory cells, and including allergic or hypersensitivity and anaphylactic or anaphylactoid insults”. “It is caused by inflammatory mediators such as histamine, neutral proteases, arachidonic acid products, platelet activating factor and a variety of cytokines and chemokines released during the activation process”

Historical background:

1950: Pfister CW, et al. Acute myocardial infarction during a prolonged allergic reaction to penicillin. Am Heart J 1950; 40: 945

1965: Zosin P, et al. Allergic myocardial infarction. Romanian Medical Review 1965;19: 26

1991: Kounis NG, et al. Histamine-induced coronary artery spasm: the syndrome of allergic angina. Br J Clin Pract 1991; 45: 121

1995: Constantinides P. “ Allergic reactions can promote plaque disruption” Circulation 1995; 92: 1083

1996: Kounis NG, et al. Allergic angina and allergic myocardial infarction. Circulation 1996; 94: 1789

1998: Braunwald E. “ Allergic reactions with mediators such as histamine or leukotrienes acting on coronary smooth muscle can induce vasospastic angina” Circulation 1998;98: 2219

2003: Zavras GM, et al. Kounis syndrome secondary to allergic reaction. Int J Clin Pract 2003; 57: 62

2006: Kounis NG. Kounis syndrome. Int J Cardiol 2006; 119: 7

2006: Kounis NG, et al. Hypersensitivity to DES: a manifestation of Kounis syndrome? J Am Coll Cardiol 2006; 48: 592

2007: Kounis NG, et al. Coronary stents , Hypersensitivity and the Kounis Syndrome. J Interv Cardiol 2007; 20: 314

2008:Tavil Y, et al. Kounis syndrome secondary to amoxicillin/clavulanic acid use. Int J Cardiol. 2008 20; 124: e4-7

Kounis syndrome variants:

Type I variant: includes patients with normal coronary arteries without predisposing factors for coronary artery disease in whom the acute release of inflammatory mediators can induce either coronary artery spasm without increase of cardiac enzymes and troponins or coronary artery spasm progressing to acute myocardial infarction with raised cardiac enzymes and troponins

Type II variant: includes patients with culprit but quiescent pre-existing atheromatous disease in whom the acute release of inflammatory mediators can induce either coronary artery spasm with normal cardiac enzymes and troponins or plaque erosion or rupture manifesting as acute myocardial infarction

Causes of Kounis syndrome:

Conditions

Angio-edema

Bronchial asthma

Exercise induced anaphylaxis

Food allergy

Idiopathic anaphylaxis

Mastocytosis

Serum sickness

Urticaria

Churg-Strauss syndrome

Drugs

Antibiotics

Analgesics

Antineoplastics

Contrast Media

Corticosteroids

Intravenous anaesthetics

Non steroidal

Anti-inflammatory

Drugs (NSAIDs)

Skin disinfectants

Thrombolytics

Anticoagulants

Others

Environmental exposures

Ant stings

Bee stings

Wasp stings

Jellyfish sting

Grass cutting

Poison ivy

Latex contact

Limpet ingestion (The kiss of death)

Millet allergy

Shellfish eating (The kiss of death)

Viper venom poisoning

Drug-nduced Kounis syndrome:

Antibiotics

Ampicillin

Ambicillin/sulfactam

Amoxicillin

Amikacin

Cafazolin

Cefoxitin

Cerufoxime

Cephradine

Cinoxacin

Lincomycin

Penicillin

Sulbactam/cefoperazone

Sulperazon

Vancomycin

Contrast media

Iohexone

Loxagate

Meglumine diatrizoate

Sodium indigotindisulfonate

Corticosteroids

Betamethasone

Hydrocortisone

Analgesics

Dipyrone

Antineoplasics

5-fluoroucacil

Capecitabine

Carboplatin

Denileukin

Interferons

Paclitaxel

Vinca alkaloids

Intravenous anaesthetics

Etomidate

Rocuronium bromide

Suxamethonium

Trimethaphan

NSAIDs

Diclofenac

Naproxen

Thrombolytics and anticoagulants

Heparin

Lepirudin

Streptokinase

Urokinase

Skin disinfectants

Chlorhexidine

Povidone-iodine

Others

Allopurinol

Enalapril

Esmolol

Dextran 40

Fructose

Insulin

Iodine

Protamine

Tetanus antitoxin

Glaphenine

Management of Kounis syndrome:

1. Treatment of allergic event (alone can abolish type I variant!)

2. Treatment of acute coronary event

Clinical implications of Kounis syndrome

So far, it has been shown that the same mediators, released during acute allergic

episodes, are increased in blood or urine

of patients suffering from acute coronary syndromes of nonallergic

etiology. Consequently, the same substances from the same cells are

present in both acute allergic episodes and acute coronary

syndromes. Does, therefore, Kounis syndrome represent a magnificent

natural paradigm and nature’s own experiment in a

final trigger pathway implicated in cases of coronary artery

spasm and plaque rupture? Drugs and natural molecules which stabilize mast cell membrane and monoclonal antibodies that protect mast cell surface could emerge as novel therapeutic modalities capable to prevent acute coronary and cerebrovascular events.

[PLUS contribution/CRM 2008]

(Edit)

External Links Related to Kounis syndrome/Allergic Coronary Spasm - Causes
Google
Wikipedia
Merck
Images
PubMed (National Library of Medicine)
NGC (National Guideline Clearinghouse)
Medscape (eMedicine)
Harrison's Online (accessmedicine)
NEJM (The New England Journal of Medicine)
Ads