A Rare Presentation of Kounis Syndrome Induced by an Echocardiography Contrast
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ABSTRACT:
SUBMITTER: Sagalov A
PROVIDER: S-EPMC10591133 | biostudies-literature | 2023 Jul
REPOSITORIES: biostudies-literature
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Project description:Immune-mediated acute coronary syndrome, also known as Kounis syndrome (KS), is an underrecognized and challenging diagnosis. In this case report, we present a case of cardiac arrest secondary to iodinated contrast allergy requiring emergent cardiac catheterization and hemodynamic support secondary to type 2 KS. KS necessitates a high index of clinical suspicion by the treating physician in order to address both the hypersensitivity reaction and its cardiac implications.Learning objectivesKounis syndrome (KS) is a clinically distinct entity from anaphylaxis; managing KS in the same way as anaphylaxis can worsen cardiac demand and ischemia. In addition, KS may present as coronary vasospasm or plaque rupture; regardless, percutaneous coronary intervention (PCI) should be performed as worse outcomes have been described in cases where PCI is not performed or delayed.
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Project description:Kounis syndrome (KS) is an acute coronary disorder associated with anaphylactic reactions. The purpose of this report is to identify the features of KS triggered by contrast media on the basis of our experience and from literature review. We have described a case and literature review of KS triggered by injection of contrast media. Including the present case, we reviewed eleven cases of KS. Six cases developed KS in diagnostic radiology departments. KS could be induced by intravenous injection of contrast media in the radiology department. Radiologists should recognize this critical condition to ensure appropriate management.
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Project description:Kounis syndrome (KS) is a rare condition characterized by acute myocardial infarction during an allergic reaction. It is classified into three subtypes based on pathophysiology. SonoVue, an ultrasound contrast agent that allows the evaluation of myocardial perfusion, is generally safe with a low incidence of severe adverse reactions. A 44-year-old man with a recent acute coronary syndrome treated with one stent implantation in the left circumflex artery underwent a contrast-enhanced stress perfusion echocardiography. Shortly after SonoVue administration, he developed diffuse rash, hypotension, tachycardia, and ultimately chest pain with an inferolateral ST-segment elevation myocardial infarction (STEMI) with 2:1 atrioventricular block. Coronary angiography revealed mild diffused coronary spasm and stent thrombosis at the proximal edge of the recently placed stent. After mechanical thrombectomy Optical Coherence Tomography was performed and revealed significant stent underexpansion and malapposition. The patient was treated with additional stent implantation in proximal overlap with the previously placed stent and he was discharged on the 7th post-operative day with a fully recovered left ventricular function. The case illustrates a rare combination of KS and an anaphylactic reaction to a contrast agent. The allergic reaction triggered type 3 KS with stent thrombosis and diffuse coronary vasospasm. Stent malapposition and underexpansion further facilitated thrombosis. Management included aggressive fluid resuscitation and norepinephrine, while epinephrine was avoided due to the risk of worsening coronary vasospasm. Serum tryptase levels were normal, possibly due to timing of sampling. Drug-coated balloon angioplasty was considered but it wasn't feasible due to stent undersizing.
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Project description:Kounis syndrome (KS) has been defined as acute coronary syndrome (ACS) in the context of a hypersensitivity reaction. Patients may present with normal coronary arteries (Type I), established coronary artery disease (Type II) or in-stent thrombosis and restenosis (Type III). We searched PubMed until 1 January 2020 for KS case reports. Patients with age <18 years, non-coronary vascular manifestations or without an established diagnosis were excluded. Information regarding patient demographics, medical history, presentation, allergic reaction trigger, angiography, laboratory values and management were extracted from every report. The data were pulled in a combined dataset. From 288 patients with KS, 57.6% had Type I, 24.7% Type II and 6.6% Type III, while 11.1% could not be classified. The mean age was 54.1 years and 70.6% were male. Most presented with a combination of cardiac and allergic symptoms, with medication being the most common trigger. Electrocardiographically, 75.1% had ST segment elevation with only 3.3% demonstrating no abnormalities. Coronary imaging was available in 84.8% of the patients, showing occlusive lesions (32.5%), vascular spasm (16.2%) or normal coronary arteries (51.3%). Revascularization was pursued in 29.4% of the cases. In conclusion, allergic reactions may be complicated by ACS. KS should be considered in the differential diagnosis of myocardial infarction with non-obstructive coronary arteries.
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