Acute coronary syndrome secondary to allergic coronary vasospasm (Kounis Syndrome): a case series, follow-up and literature review

Abstract

Kounis syndrome is not rare but rarely recognized and under-diagnosed. It is necessary to recognize KS and various inducers, especially for the patients suffering refractory vasospastic cardiac attacks concentrating in special periods. Blood test of eosinophil might contribute to diagnose KS and anti-allergic agents might be helpful for controlling KS attacks.

Kounis syndrome secondary to gadolinium contrast agent

“…5 More than 300 cases of KS have been described following exposure to various substances, including drugs (antibiotics, anesthetics, analgesics, corticosteroids, contrast agents, acetylsalicylic acid), insect venom, food, and drug-eluting stents. 6 The pathophysiology of KS is thought to be caused by coronary artery vasospasm due to the release of vasoactive mediators secondary to mast cell degranulation. During mast cell degranulation, several vasoactive compounds and collagen-degrading compounds are released, resulting in a powerful vasoconstriction of the coronary arteries.…”

Prinzmetal angina. Questions of pathogenesis, clinic, diagnosis and treatment

“…Необходимо тщательно изучать неспецифические жалобы, которые могут быть расценены как психическое рас-стройство (особенно у женщин) [46]. Важным считается дифференцировать ВССТ, особенно рефрактерного течения, с синдромом Коуниса, который встречается не так редко, но редко диагностируется, по клинике напоминает ОКС, но ассоциирован с активацией тучных клеток и тромбоцитов в развитии гиперсенситивности и аллергических реакций [47,48].…”

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

“…In 1991, Nicholas Kounis described the relationship between allergies and acute coronary syndromes [3] and used the terms "allergic angina" and "allergic infarction" to define the syndrome. Today, there are over 300 Kounis syndrome cases described in medical literature [4]. Additionally, three types of Kounis syndrome have been characterized [5].…”

“…Histamine, platelet-activating factors (PAFs), cytokines, and the products of the arachidonic acid [8] have been linked to the development of the coronary artery spasm and atheromatous plaque erosion or rupture (see Figure 1). Interestingly, eosinophils seem to bear importance in mast cell activation, as suggested by the peripheral eosinophilia and myocardial eosinophilic infiltration, which are common in Kounis syndrome [4,[9][10][11]. The systemic effects have a potential impact on the myocardial tissue through hypotension, resulting in hypoperfusion and subsequent ischemia.…”