Síndrome de Kounis: una revisión exhaustiva
Kounis Syndrome: an exhaustive review
Barra lateral del artículo
PDF
FLIP
Contenido principal del artículo
Resumen
Introducción: el síndrome de Kounis se ha establecido como un trastorno coronario asociado a reacciones alérgicas, de hipersensibilidad, anafilácticas y anafilactoides; que engloba conceptos como el de angina alérgica e infarto alérgico. Su incidencia ha sido difícil de establecer debido a que posee una gran cantidad de factores desencadenantes y que existen pocos registros en la literatura médica, de modo que no parece ser un síndrome raro sino una entidad clínica poco conocida, capaz de evolucionar fatalmente si no se reconoce y se trata de manera rápida.
Objetivo: Resaltar y consolidar la literatura reciente sobre el síndrome de Kounis y así actualizar los conocimientos del médico en dicho tópico.
Métodos: se realizó una revisión narrativa de la literatura encontrada en las bases de datos PubMed y Science Direct y en el motor de búsqueda Google Scholar utilizando las palabras claves. Se incluyeron artículos en idioma español e inglés publicados hasta el mes de agosto de 2021.
Resultados: las reacciones alérgicas graves pueden desencadenar eventos coronarios agudos, esto se conoce como síndrome de Kounis. Se han descrito múltiples causas y sus manifestaciones clínicas pueden variar. La participación de los mastocitos cardíacos es fundamental en su desarrollo, a través de la liberación de múltiples mediadores que pueden desencadenar eventos agudos como vasoconstricción coronaria, rotura de placa ateroesclerótica y trombosis del stent coronario. Su diagnóstico se basa en las características clínicas, así como en pruebas de laboratorio, electrocardiográficas, ecocardiográficas y angiográficas. A pesar de que no existen guías de tratamiento para los pacientes con esta entidad, la literatura parece estar de acuerdo en que el manejo de dicha entidad en su fase aguda, debe involucrar el tratamiento del síndrome coronario agudo y la supresión de la reacción alérgica, teniendo en cuenta las interacciones y efectos de los fármacos a emplear.
Conclusión: El síndrome de Kounis es un trastorno común y potencialmente mortal que se debe diagnosticar y tratar de forma idónea e inmediata; por tanto, el conocimiento de su epidemiología, etiología, patogenia y manifestaciones clínicas son importantes para su diagnóstico, y tratamiento. El clínico debe prestar especial atención ante cualquier reacción alérgica que preceda al evento cardíaco agudo y considerar el SK en el gabinete de diagnósticos diferenciales.
Palabras clave:
Descargas
Detalles del artículo
Referencias (VER)
Kounis NG. Kounis syndrome: An update on epidemiology, pathogenesis, diagnosis and therapeutic management. Clin Chem Lab Med. 2016; 54(10): 1545–59. DOI: 10.1515/cclm-2016-0010 DOI: https://doi.org/10.1515/cclm-2016-0010
Kounis NG, Zavras GM. Histamine-induced coronary artery spasm: The concept of allergic angina. Br J Clin Pract. 1991;45(2):121–8.
Brawnwald E. Unstable angina. An etiologic approach to management. Circulation 1998;98:2219–22. DOI: : 10.1161/01.cir.98.21.2219 DOI: https://doi.org/10.1161/01.CIR.98.21.2219
Rich MW. Is vasospastic angina an inflammatory disease? Am J Cardiol. 2005;96(11):1612. DOI: 10.1016/j.amjcard.2005.02.061 DOI: https://doi.org/10.1016/j.amjcard.2005.02.061
Kounis NG, Cervellin G, Koniari I, Bonfanti L, Dousdampanis P, Charokopos N, et al. Anaphylactic cardiovascular collapse and Kounis syndrome: systemic vasodilation or coronary vasoconstriction?. Ann Transl Med. 2018;6(17):332–332. DOI: 10.21037/atm.2018.09.05 DOI: https://doi.org/10.21037/atm.2018.09.05
Rico-Cepeda P, Palencia-Herrejón E, Rodríguez-Aguirregabiria MM. Síndrome de Kounis. Med Intensiva. 2012;36(5):358-64. DOI: 10.1016/j.medin.2011.10.008 DOI: https://doi.org/10.1016/j.medin.2011.10.008
Helbling A, Hurni T, Mueller UR, Pichler WJ. Incidence of anaphylaxis with circulatory symptoms: a study over a 3-year period comprising 940,000 inhabitants of the Swiss Canton Bern. Clin Exp Allergy 2004;34:285–90. DOI: 10.1111/j.1365-2222.2004.01882.x DOI: https://doi.org/10.1111/j.1365-2222.2004.01882.x
Akoz A, Tanboga HI, Emet M, Bayramoglu A, Kizrak Y, Kantarci M, et al. A prospective study of kounis syndrome: Clinical experience and cardiac magnetic resonance imaging findings for 21 patients. Acta Medica Mediterr. 2013;29(4):811–6.
Renda F, Landoni G, Trotta F, Piras D, Finco G, Felicetti P, et al. Kounis Syndrome: an analysis of spontaneous reports from international pharmacovigilance database. Int J Cardiol 2016; 203: 217–20. DOI: 10.1016/j.ijcard.2015.10.003 DOI: https://doi.org/10.1016/j.ijcard.2015.10.003
Lippi G, Buonocore R, Schirosa F, Cervellin G. Cardiac troponin I is increased in patients admitted to the emergency department with severe allergic reactions. A case-control study. Int J Cardiol 2015; 194: 68–9. DOI: 10.1016/j.ijcard.2015.05.093 DOI: https://doi.org/10.1016/j.ijcard.2015.05.093
Giovannini M, Alletto A, Koniari I, Mori F, Favilli S, Sarti L, et al. Kounis syndrome: A pediatric perspective. Minerva Pediatr. 2020;72(5):383–92. DOI: 10.23736/S0026-4946.20.06007-7 DOI: https://doi.org/10.23736/S0026-4946.20.06007-7
Sueda S, Sasaki Y, Habara H, Kohno H. Editorial: Kounis syndrome (allergic angina and allergic myocardial infarction) for cardiologists. J Cardiol Cases. 2015;12(4):110–2. DOI: 10.1016/j.jccase.2015.07.006 DOI: https://doi.org/10.1016/j.jccase.2015.07.006
Villamil-Munévara PA, Sánchez-Solanilla LF. Síndrome de Kounis o angina alérgica. Rev Colomb Cardiol. 2017;24(4):382-87. DOI: 0.1016/j.rccar.2016.10.042 DOI: https://doi.org/10.1016/j.rccar.2016.10.042
Kounis NG, Koniari I, Roumeliotis A, Tsigas G, Soufras G, Grapsas N, et al. Thrombotic responses to coronary stents, bioresorbable scaffolds and the Kounis hypersensitivity-associated acute thrombotic syndrome. J Thorac Dis. 2017;9(4):1155–64. DOI: 10.21037/jtd.2017.03.134 DOI: https://doi.org/10.21037/jtd.2017.03.134
Coppola G, Caccamo G, Bacarella D, Corrado E, Caruso M, Cannavò MG, et al. Vasospastic angina and scombroid syndrome: a case report. Acta Clin Belg 2012;67:222–5. DOI: 10.2143/ACB.67.3.2062661
Kounis NG, Patsouras N, Grapsas N, Hahalis G. Histamine induced coronary artery spasm, fish consumption and Kounis syndrome. Int J Cardiol 2015;193:39–41. DOI: 10.1016/j.ijcard.2015.05.038. DOI: https://doi.org/10.1016/j.ijcard.2015.05.038
Barbarroja-Escudero J, Rodriguez-Rodriguez M, Sanchez-Gonzalez MJ, Antolin-Amerigo D, Alvarez-Mon M. Anisakis simplex: a new etiological agent of Kounis syndrome. Int J Cardiol 2013;167:e187–9. DOI:10.1016/j.ijcard.2013.04.058 DOI: https://doi.org/10.1016/j.ijcard.2013.04.058
Guler Y, Kalkan S, Esen AM. An extremely rare trigger of Kounis syndrome: actinidia chinensis. Int J Cardiol 2014;172:e324–5. DOI: 10.1016/j.ijcard.2013.12.160 DOI: https://doi.org/10.1016/j.ijcard.2013.12.160
Wilson BJ, Musto RJ, Ghali WA. A case of histamine fish poisoning in a young atopic woman. J Gen Intern Med 2012;27:878–81 DOI: https://doi.org/10.1007/s11606-012-1996-6
Pravettoni V, Primavesi L, Piantanida M. Anisakis simplex: current knowledge. Eur Ann Allergy Clin Immunol 2012;44: 150–6
Gázquez V, Dalmau G, Gaig P, Gómez C, Navarro S, Mercé J. Kounis syndrome: report of 5 cases. J Investig Allergol Clin Immunol. 2010;20(2):162-5.
Fine AJ. Hypersensitivity reaction to kiwi fruit (Chinese gooseberry, Actinidia chinensis). J All Clin Immunol 1981;68:235–7. DOI: 10.1016/0091-6749(81)90189-5 DOI: https://doi.org/10.1016/0091-6749(81)90189-5
Bublin M. Kiwifruit allergies. Adv Food Nutr Res 2013;68: 321–40. DOI: 10.1016/B978-0-12-394294-4.00018-3 DOI: https://doi.org/10.1016/B978-0-12-394294-4.00018-3
Juste JFM, Garces TR, Enguita RG, Blasco PC, Trallero JA. Cardiac complications in a metamizole-induced type I Kounis syndrome. Brazilian J Anesthesiol (English Ed). 2016;66(2):194–6. DOI: 10.1016/j.bjane.2013.07.008 DOI: https://doi.org/10.1016/j.bjane.2013.07.008
El Hangouche AJ, Lamliki O, Oukerraj L, Dakka T, Doghmi N, Zarzur J, et al. Kounis syndrome induced by oral intake of aspirin: Case report and literature review. Pan Afr Med J. 2018;30:1–7. DOI: 10.11604/pamj.2018.30.301.14948 DOI: https://doi.org/10.11604/pamj.2018.30.301.14948
Cagliyan CE, Balli M, Tekin K, Turkmen S, Tanboga IH. Kounis syndrome triggered by diclofenac sodium injection which leads to myocardial infarction and cardiac arrest. J Cardiol Cases. 2013;8(1):17–9. DOI: 10.1016/j.jccase.2013.03.002 DOI: https://doi.org/10.1016/j.jccase.2013.03.002
Akoz A, Bayramoglu A, Uzkeser M, Kantarci M, Aksakal E, Emet M. Two questions for Kounis syndrome: can we use magnetic resonance imaging in the diagnosis and does ST elevation correlates with troponin levels?. Am J Emerg Med. 2012;30(9):7–9. DOI: 10.1016/j.ajem.2011.12.016 DOI: https://doi.org/10.1016/j.ajem.2011.12.016
Renda F, Marotta E, Landoni G, Belletti A, Cuconato V, Pani L. Kounis syndrome due to antibiotics: A global overview from pharmacovigilance databases. Int J Cardio. 2016; 224: 406–11. DOI: 10.1016/j.ijcard.2016.09.066 DOI: https://doi.org/10.1016/j.ijcard.2016.09.066
Leibee C, Getachew B, Ehmann MR. Vancomycin-induced Kounis Syndrome. Am J Emerg Med. 2019;37(9):1806.e3-1806.e5. DOI: 10.1016/j.ajem.2019.06.004 DOI: https://doi.org/10.1016/j.ajem.2019.06.004
Takagi S, Goto Y, Hirose E, Terashima M, Sakuragi S, Suzuki S, et al. Successful treatment of refractory vasospastic angina with corticosteroids-coronary arterial hyperreactivity caused by local inflammation?. Circ J 2004; 68: 17–2. DOI: 10.1253/circj.68.17
Arslan Z, Iyisoy A, Tavlasoglu M. Acute myocardial infarction after prednisolone administration for the treatment of anaphylaxis caused by a wasp sting. Cardiovasc J Africa 2013;24:e4–6. DOI: https://doi.org/10.5830/CVJA-2013-013
Kounis GN, Hahalis G, Kounis NG. Anesthetic drugs and Kounis syndrome. J Clin Anesth. 2008;20(7):562-3; author reply 563-4. DOI: 10.1016/j.jclinane.2008.06.004.
Priyankara WDD, Manoj EM, Gunapala A, Ranaweera AGRMA, Vithanage KS, Sivasubramanium M, Snajeeva E. Cardiogenic Shock due to Kounis Syndrome following Cobra Bite. Case Rep Crit Care. 2019; 2019:5185716. DOI: 10.1155/2019/5185716 DOI: https://doi.org/10.1155/2019/5185716
Castellano-mart A. Vasoespasmo coronario en un niño alérgico al látex: síndrome de Kounis. Arch Argent Pediatr. 2019;117(5):514–8. DOI:10.5546/aap.2019.e514 DOI: https://doi.org/10.5546/aap.2019.e514
Rosier SE, Otten R, Brugts JJ, Hoek AE. Allergic acute coronary syndrome in exercise-induced anaphylaxis. Neth J Med. 2018;76(9):411–4.
Steensma DP. The kiss of death: a severe allergic reaction to a shellfish induced by a good-night kiss. Mayo Clin Proc 2003;78:221–2. DOI: 10.4065/78.2.221 DOI: https://doi.org/10.4065/78.2.221
Kounis NG, Giannopoulos S, Goudevenos J. Beware of, not only the dogs, but the passionate kissing and the Kounis syndrome. J Cardiovasc Med (Hagerstown) 2011;12:149–50. DOI: 10.2459/JCM.0b013e328341aeaf DOI: https://doi.org/10.2459/JCM.0b013e328341aeaf
Abdelghany M, Subedi R, Shah S, Kozman H. Kounis syndrome: A review article on epidemiology, diagnostic findings, management and complications of allergic acute coronary syndrome. Int J Cardiol. 2017;232:1–4. DOI: 10.1016/j.ijcard.2017.01.124 DOI: https://doi.org/10.1016/j.ijcard.2017.01.124
Sciatti E, Vizzardi E, Cani DS, Castiello A, Bonadei I, Savoldi D, et al. Kounis syndrome, a disease to know: Case report and review of the literatura. Monaldi Archives for Chest Disease 2018; volume 88:898. DOI: 10.4081/monaldi.2018.898 DOI: https://doi.org/10.4081/monaldi.2018.898
Varricchi G, Marone G, Kovanen PT. Cardiac Mast Cells: Underappreciated Immune Cells in Cardiovascular Homeostasis and Disease. Trends Immunol. 2020;1–13. DOI: 10.1016/j.it.2020.06.006 DOI: https://doi.org/10.1016/j.it.2020.06.006
Giannetti A, Filice E, Caffarelli C, Ricci G, Pession A. Mast Cell Activation Disorders. MDPI. 2021;57(124):13. DOI: DOI: 10.3390/medicina57020124 DOI: https://doi.org/10.3390/medicina57020124
Whittemore M, Dileepan K, Wood J. Mast Cell: A Multi-Functional. Front Immunol. 2015; 6: 620. DOI: DOI: 10.3389/fimmu.2015.00620 DOI: https://doi.org/10.3389/fimmu.2015.00620
Brown SGA. Cardiovascular aspects of anaphylaxis: implications for treatment and diagnosis. Curr Opin Allergy Clin Immunol. 2005;5(4):359-64. DOI: 10.1097/01.all.0000174158.78626.35 DOI: https://doi.org/10.1097/01.all.0000174158.78626.35
Fassio F, Almerigogna F. Kounis syndrome (allergic acute coronary syndrome): different views in allergologic and cardiologic literature. 2012;7:489–95. DOI: 10.1007/s11739-012-0754-4. DOI: https://doi.org/10.1007/s11739-012-0754-4
Méndez-Betancourt JL, Ramirez-Ramos CF, López-Guevara OA, Osorio-Carmona HE. Síndrome de Kounis, a propósito de un caso. Acta méd. Peru. 2018; 35(1): 65-70. DOI: https://doi.org/10.35663/amp.2018.351.381
Kounis NG. Kounis syndrome (allergic angina and allergic myocardial infarction): A natural paradigm? Int J Cardiol. 2006; 110: 7–14. DOI: 10.1016/j.ijcard.2005.08.007. DOI: https://doi.org/10.1016/j.ijcard.2005.08.007
Theoharides T, Valent P, Akin C. Mast Cells, Mastocytosis, and Related Disorders. N Engl J Med. 2015;373:163–72. DOI: 10.1056/NEJMra1409760 DOI: https://doi.org/10.1056/NEJMra1409760
Gilfillan AM, Tkaczyk C. Integrated signalling pathways for mast-cell activation. Nat Rev Immunol. 2006;6(3):218-30. DOI: 10.1038/nri1782. DOI: https://doi.org/10.1038/nri1782
Kounis GN, Kounis SA, Hahalis G, Kounis NG. Coronary artery spasm associated with eosinophilia: another manifestation of Kounis syndrome? Heart lung Circ. 2009; 18:163-4. DOI: 10.1016/j.hlc.2008.09.008. DOI: https://doi.org/10.1016/j.hlc.2008.09.008
Hattori Y, Hattori K, Matsuda N. Regulation of the Cardiovascular System by Histamine. Handb Exp Pharmacol. 2017; 241:239-258. DOI: 10.1007/164_2016_15. DOI: https://doi.org/10.1007/164_2016_15
Guilarte M, Cardona V, Labrador M. Kounis Syndrome. Curr Treat Options Allergy. 2019; 6:289–296 DOI 10.1007/s40521-019-00210-5 DOI: https://doi.org/10.1007/s40521-019-00210-5
Kounis NG, Tsigkas G, Almpanis G. Tryptase levels in coronary syndromes and in hypersensitivity episodes: a common pathway towards Kounis syndrome. Atherosclerosis. 2011; 219 (1):28-9. DOI: 10.1016/j.atherosclerosis.2011.07.101 DOI: https://doi.org/10.1016/j.atherosclerosis.2011.07.101
Kounis NG, Soufras GD, Tsigkas G, Hahalis G. White blood cell counts, leukocyte ratios, and eosinophils as inflammatory markers in patients with coronary artery disease. Clin Appl Thromb Hemost. 2015;21 (2):139-43. DOI: 10.1177/1076029614531449. DOI: https://doi.org/10.1177/1076029614531449
Kounis NG, Giannopoulos S. Tsigkas GG, Goudevenos J.;1; Eosinophilic responses to stent implantation and the risk of Kounis hypersensitivity associated coronary syndrome. Int J Cardiol. 2012; 156(2):125-32. DOI: 10.1016/j.ijcard.2011.05.052. DOI: https://doi.org/10.1016/j.ijcard.2011.05.052
Xu M, Wu X, Jiang TY, He JQ. Kounis syndrome: allergic acute coronary syndrome. Chin Med J. 2013;126:2591-2.
Niccoli G, Calvieri C, Flego D, Scalone G, Imaeva A, Sabato V, et al. Allergic inflammation is associated with coronary instability and a worse clinical outcome after acute myocardial infarction. Circ Cardiovas Interv. 2015; 8 (8): e002554. DOI: 10.1161/CIRCINTERVENTIONS.115.002554. DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.115.002554
Fourie P. Kounis syndrome: a narrative review. South Afr J Anaesth Analg. 2016; 22:72-80. DOI: 10.1080/22201181.2016.1154309 DOI: https://doi.org/10.1080/22201181.2016.1154309
Soufras GD, Lianas D, Patsouras N, Tsigkas G, Kounis NG. Kounis syndrome: Aspects on pathophysiology and management. Eur J Intern Med. 2016;32: e30-1. DOI: 10.1016/j.ejim.2016.02.001 DOI: https://doi.org/10.1016/j.ejim.2016.02.001
Kounis NG, Soufras G, Hahalis G. Anaphylactic Shock: Kounis Hypersensitivity - Associated Syndrome Seems to be the Primary Cause. N Am J Med Sci. 2013; 5 (11):31-6. DOI: 10.4103/1947-2714.122304 DOI: https://doi.org/10.4103/1947-2714.122304
Puvanalingam A, Karpagam P, Sundar C, Venkatesan S, Ragunanthanan. Myocardial infarction following bee sting. J Assoc Physian I. 2014; 62 (8):738-40
Zavras GM, Papadaki PJ, Kokkinis CE, Kalokairinov K, Kouni SN, Batsolaki M, et al. Kounis syndrome secondary to allergic reaction following shellfish ingestion. Int J Clin Pract. 2003; 57 (7):622-4.
Kounis NG, Soufras GD, Davlouros P, Tsigkas G, Hahalis G. Combined etiology of anaphylactic cardiogenic shock: Amiodarone, epinephrine, cardioverter defibrillator, left ventricular assist devices and the Kounis syndrome. Ann Cardiac Anaesthesia. 2015; 8 (2):261-4. DOI: 10.4103/0971-9784.154498 DOI: https://doi.org/10.4103/0971-9784.154498
Kounis NG, Davlouros P, Hahalis G, Mazarakis A. The heart seems to be the primary site and the target of anaphylaxis resulting in the development of Kounis syndrome. Intern Emerg Med. 2012;7 Suppl 2: S119-20. DOI: 10.1007/s11739-012-0786-9. DOI: https://doi.org/10.1007/s11739-012-0786-9
Li J, Zheng J, Zhou Y, Liu X, Peng W. Acute coronary syndrome secondary to allergic coronary vasospasm (Kounis Syndrome): a case series, follow-up and literature review. BMC Cardiovasc Disord. 2018 (1):42. DOI: 10.1186/s12872-018-0781-9 DOI: https://doi.org/10.1186/s12872-018-0781-9
Chang KL, Chen J, Yu J, Dou XL. Kounis syndrome leads to cardiogenic shock. Cardiovasc J Afr. 2013;24(9-10):e12-6. DOI: 10.5830/CVJA-2013-075 DOI: https://doi.org/10.5830/CVJA-2013-075
Bastante T, Rivero F, Cuesta J, Benedicto A, Restrepo J, Alfonso F. Nonatherosclerotic causes of acute coronary syndrome: recognition and management. Curr Cardiol Rep. 2014;16(11):543. DOI: 10.1007/s11886-014-0543-y DOI: https://doi.org/10.1007/s11886-014-0543-y
M. Çeliker, M. Tuncer, A. Fekeralmaz. A case with repeated recurrent acute coronary syndrome due to pseudoephedrine use: Kounis syndrome. Case Rep Med. 2014:742905. DOI: 10.1155/2014/742905 DOI: https://doi.org/10.1155/2014/742905
Castells M, Irani AA, Scwartz LB. Evaluation of human peripheral blood leucocytes for mast cell tryptase. J Immunol 1987;138 (1):2814–9
Kounis NG. Serum tryptase levels and Kounis syndrome. Int J Cardiol. 2007; 114(3):407-8. DOI: 10.1016/j.ijcard.2005.11.088. DOI: https://doi.org/10.1016/j.ijcard.2005.11.088
Sravan A, Tse R, Cala AD. A decline in 2 consecutive postmortem serum tryptase levels in an anaphylactic death. Am J Forensic Med Pathol 2015;36 (4):233–5. DOI: 10.1097/PAF.0000000000000185 DOI: https://doi.org/10.1097/PAF.0000000000000185
Cha YS, Kim H, Bang MH, Kim OH, Kim HI, Cha K, et al. Evaluation of myocardial injury through serum troponin I and echocardiography in anaphylaxis. Am J Emerg Med. 2015; 34 (2): 140-44. DOI: 10.1016/j.ajem.2015.09.038 DOI: https://doi.org/10.1016/j.ajem.2015.09.038
Kounis NG. Kounis syndrome should be considered the culprit cause of the most feared stent thrombosis. J Am Coll Cardiol 2011;58 (8):885 DOI: 10.1016/j.jacc.2010.11.082 DOI: https://doi.org/10.1016/j.jacc.2010.11.082
Goto K, Kasama S, Sato M, Kurabayashi M. Myocardial scintigraphic evidence of Kounis syndrome: what is the aetiology of acute coronary syndrome? Eur Heart J. 2016 Apr 7;37(14):1157. DOI: 10.1093/eurheartj/ehv703 DOI: https://doi.org/10.1093/eurheartj/ehv703
Okur A, Kantarci M, Karaca L, Ogul H, Aköz A, Kızrak Y, et al. The utility of cardiac magnetic resonance imaging in Kounis syndrome. Postepy Kardiol Interwencyjnej. 2015; 11(3): 218–223. DOI: 10.5114/pwki.2015.54017 DOI: https://doi.org/10.5114/pwki.2015.54017
Margonato D, Abete R, Di Giovine G, Delfino P, Grillo M, Mazzetti S, Poggio D, Rossi J, Khouri T, Mortara A. Takotsubo cardiomyopathy associated with Kounis syndrome: A clinical case of the "ATAK complex". J Cardiol Cases. 2019 ;20(2):52-56. DOI: 10.1016/j.jccase.2019.03.007 DOI: https://doi.org/10.1016/j.jccase.2019.03.007
Biteker M, Duran NE, Biteker FS, Civan HA, Kaya H, Gökdeniz T, Yildiz M, Ozkan M. Allergic myocardial infarction in childhood: Kounis syndrome. Eur J Pediatr. 2010 Jan;169(1):27-9. DOI: 10.1007/s00431-009-0965-5 DOI: https://doi.org/10.1007/s00431-009-0965-5
Kounis NG, Koniari I, Velissaris D, Tzanis G, Hahalis G. Kounis Syndrome—not a Single-organ Arterial Disorder but a Multisystem and Multidisciplinary Disease. Balkan Med J. 2019;36(4):212–21. DOI: https://doi.org/10.4274/balkanmedj.galenos.2019.2019.5.62
Rajha E, Didi A, Dakik H, Mufarrij A. Acute ST Elevation Myocardial Infarction Due to Allergic Reaction, Kounis Syndrome. Am J Emerg Med. 2020;38(2):409.e5-409.e7. DOI: 10.1016/j.ajem.2019.10.006 DOI: https://doi.org/10.1016/j.ajem.2019.10.006
Ramey JT, Lockey RF. Allergic and nonallergic reactions to nitroglycerin. Allergy Asthma Proc 2006;27 (3):273–80. DOI: 10.2500/aap.2006.27.286 DOI: https://doi.org/10.2500/aap.2006.27.2860
Cevik C, Nugent K, Shome GP, Kounis NG. Treatment of Kounis syndrome. Int J Cardiol 2010;143 (3):223–6. DOI: 10.1016/j.ijcard.2010.02.040 DOI: https://doi.org/10.1016/j.ijcard.2010.02.040
Domínguez Franco AJ, Gómez Doblas JJ, García Pinilla JM, Hernández García JM, Jiménez Navarro M, Alonso Briales JH, de Teresa Galvan E. Treatment of refractory vasoespastic angina with corticosteroids. A case report. Int J Cardiol. 2007 May 31;118(2):e51-3. DOI: 10.1016/j.ijcard.2006.12.058 DOI: https://doi.org/10.1016/j.ijcard.2006.12.058
Takagi S, Goto Y, Hirose E, Terashima M, Sakuragi S, Suzuki S, Tsutsumi Y, Miyazaki S, Nonogi H. Successful treatment of refractory vasospastic angina with corticosteroids: coronary arterial hyperactivity caused by local inflammation?. Circ J. 2004 Jan;68(1):17-22. DOI: 10.1253/circj.68.17 DOI: https://doi.org/10.1253/circj.68.17
Doğan V, Mert GÖ, Biteker FS, Mert KU, Biteker M. Treatment of Kounis syndrome. Int J Cardiol. 2015;181:133-4. doi: 10.1016/j.ijcard.2014.11.171 DOI: https://doi.org/10.1016/j.ijcard.2014.11.171
Atoui R, Mohammadi S, Shum-Tim D. Surgical extraction of occluded stents: when stenting becomes a problem. Interact Cardiovasc Thorac Surg. 2009t;9(4):736-8. DOI: 10.1510/icvts.2009.210633 DOI: https://doi.org/10.1510/icvts.2009.210633
Kounis GN, Hahalis G, Kounis NG. Anesthetic drugs and Kounis syndrome. J Clin Anesth. 2008 Nov;20(7):562-3; author reply 563-4. doi: 10.1016/j.jclinane.2008.06.004. DOI: https://doi.org/10.1016/j.jclinane.2008.06.004
Almeida J, Ferreira S, Malheiro J, Fonseca P, Caeiro D, Dias A, et al. Causa rara de síndrome coronária aguda: síndrome de Kounis. Rev Port Cardiol. 2016;35(12):699.e1-699.e4. DOI: 10.1016/j.repc.2016.03.009 DOI: https://doi.org/10.1016/j.repc.2016.03.009
Liu Y, Lu C, Guo Q. Recurrent Type III Kounis Syndrome: Will Anti–Immunoglobulin E Drug Be Another Option?. Can J Cardiol. 2020;36(6):966.e5-966.e6. DOI: 10.1016/j.cjca.2019.12.007 DOI: https://doi.org/10.1016/j.cjca.2019.12.007
