Kounis syndrome

When Kounis syndrome (syn .: allergic angina , allergic heart attack , allergic acute coronary syndrome ) is it is a narrow one coronary vessel on the floor of an allergic reaction.

history

Acute coronary events associated with allergic reactions have been reported in case reports since the 1950s. In 1991, Kounis and Zavras coined the term allergic angina pectoris.

Clinical picture

In addition to the typical symptoms of an allergy ( itching , urticaria ), Kounis syndrome is accompanied by symptoms such as angina pectoris ( chest pain , shortness of breath ) and corresponding ECG changes . Long- term undersupply of oxygen to the heart muscle leads to an increase in the heart enzymes typical of infarcts . Also hypotension and bradycardia up to the shock and cardiac arrest may occur. In an acute situation, it is difficult to determine whether the latter is an expression of the systematic reaction to the allergy or to the reduced blood flow to the heart muscle.

Classification

In Kounis syndrome type I , the coronary angiography reveals an inconspicuous vascular system . It occurs in patients without relevant cardiovascular risk factors and also in children and adolescents. Endothelial dysfunction is assumed to be the cause .

The Type II is found in people with typical vascular risk profile. At least wall changes can be detected in coronary angiography. During the event, plaques are torn due to the release of vasoactive and platelet-activating messenger substances . Blood clots form on the wall injuries, which then close the coronary artery and thus trigger a heart attack .

Since 2010, allergy-triggered problems with stent vessels such as stent thrombosis have been designated as type III . A nickel allergy seems to be a leading problem here, but also possible allergies to other components such as the drug coating on DEStents .

therapy

Treating allergies and acute coronary syndrome at the same time as possible can be challenging. In addition to corticosteroids and antihistamines , the use of adrenaline and large amounts of fluids to treat the allergic reaction associated with simultaneous cardiogenic shock can be problematic.

Invasive diagnostics are recommended for acute coronary syndrome . If there is evidence of spasticity in the vascular system, vasodilating drugs ( nitroglycerin , calcium antagonists ), if necessary directly intracoronary , are used. A cardiac catheter examination may be unnecessary if, for example, one can assume that a child has a high probability of Kounis syndrome type I. Patch testing for the relevant components is recommended prior to the use of coated stents .

swell

• The allergic myocardial infarction - Kounis syndrome ; J. Kraus et al .; J Kardiol 2012; 19 (5-6): 118-22

Individual evidence

1. ↑ NG Kounis, GM Zavras: Histamine-induced coronary artery spasm: the concept of allergic angina . In: The British Journal of Clinical Practice . tape 45 , no. 2 , 1991, ISSN  0007-0947 , pp. 121-128 , PMID 1793697 .

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