Presentation Patients with this Kounis syndrome typically present with anaphylactic signs and symptoms accompanied with chest pain and associated signs and symptoms of acute coronary syndrome. [sjrhem.ca]

We present a case of a patient with no cardiac history presenting with a myocardial infarction following a wasp sting. Case: A 71-year-old male with no prior allergic history presented to the hospital following a wasp sting. [ahajournals.org]

Footnotes Poster Contributions For exact presentation time, refer to the online ACC.22 Program Planner at https://www.abstractsonline.com/pp8/#! [jacc.org]

At present, the pathogenesis of KS can be explained by the effects of mast-cell mediators on the heart. [hindawi.com]

• Swelling

  Our patient's symtoms of tongue and lip swelling with hives worsening after penacillin use complicated by cardiac arrest prompted a diagnosis of Type 1 Kounis syndrome. [journal.chestnet.org]

  He developed facial swelling and hypotension. Emergency medical services found him to be in respiratory distress associated with facial swelling. [ncbi.nlm.nih.gov]

  The patient developed swelling of the face and lips, with severe bronchoconstriction requiring intubation and mechanical ventilation. [joicc.org]

  He was admitted due to generalized itching associated with tongue swelling, dyspnea, and chest pain after the ingestion of ciprofloxacin for an acute urogenital infection 1–3 h before medical contact. He had never consumed ciprofloxacin before. [mdpi.com]

  In allergic ACS there may also be specific symptoms relating to the underlying allergic reaction, such as swelling of the face and tongue, wheeze, hives and potentially very low blood pressure (anaphylactic shock).[2] Additional findings can include stridor [en.wikipedia.org]

• Chest Discomfort

  He developed constricting chest discomfort associated with dyspnea, sweating and hypotension. [revportcardiol.org]

  History • Ms.V, a 21 year old female • Resident of Chennai • Unmarried • Educated • Well Built and Nourished • No known co-morbidities • Otherwise healthy person • Never had a chest discomfort • Never had any symptoms suggestive of cardiac or pulmonary [slideshare.net]

  A few minutes later, he regained consciousness but developed chest discomfort, with new-onset ST elevation in leads II, III, and aVF and ST depression in leads I, aVL, and V1 through V3 (Figure). [jamanetwork.com]

  Clinical symptoms Acute chest pain Chest discomfort Difficulty in swallowing Dyspnea Faintness Headache Malaise Nausea Pruritus Syncope Vomiting Urticaria Clinical signs Bradycardia or tachycardia Cardiorespiratory arrest Cold extremities Diaphoresis [medscape.com]

  A few minutes after administration of the drug, the patient had sudden chest discomfort and pain in the left arm, shortness of breath, sweating and palpitations, generalized erythema and cutaneous rashes that justified admission to Emergency Room. [clinmedjournals.org]

• Pallor

  On Examination • HR:96/min; BP:90/60mm Hg; RR:24/min; SpO2:98 on O2; JVP- not elevated • Conscious, Oriented, Afebrile, Tachypneic • NO {pallor, icterus, cyanosis, clubbing, lymphadenopathy, pedal edema} • CVS – S1S2+ ; No murmur • RS – Scattered Wheeze [slideshare.net]

  […] symptoms Acute chest pain Chest discomfort Difficulty in swallowing Dyspnea Faintness Headache Malaise Nausea Pruritus Syncope Vomiting Urticaria Clinical signs Bradycardia or tachycardia Cardiorespiratory arrest Cold extremities Diaphoresis Hypotension Pallor [medscape.com]

  Acute coronary syndrome is usually associated with a constrictive pain in the chest, characteristically with radiation to the neck or the left arm and often associated with pallor, sweatiness, nausea and breathlessness. [en.wikipedia.org]

• Malaise

  Clinical symptoms Acute chest pain Chest discomfort Difficulty in swallowing Dyspnea Faintness Headache Malaise Nausea Pruritus Syncope Vomiting Urticaria Clinical signs Bradycardia or tachycardia Cardiorespiratory arrest Cold extremities Diaphoresis [medscape.com]

  Within 10 minutes after administration, he complained of epigastric pain, malaise, shortness of breath, central chest pain, and drowsiness, and then collapsed. [annsaudimed.net]

  The patient presents a coronary syndrome that can manifest as malaise with chest pain of anginal characteristics, and simultaneously also shows symptoms typical of an anaphylactic reaction: hypotension in the context of contact with a known allergen, [medintensiva.org]

  […] was 120/70mmHg, pulse rate was 80 beat per minute, and ECG revealed no abnormalities while the symptom had relieved. 24h Holter (Figs. 11, 12 and 13) revealed ST segment elevation for 2~3 mm in leads II, III, aVF, V5, V6 at 13:40-13:42 (when he felt malaise [bmccardiovascdisord.biomedcentral.com]

• Dyspnea

  About 30 minutes after taking the antibiotic, he complained of widespread erythema in the limbs, followed by intense itching and dyspnea. [pesquisa.bvsalud.org]

  Patients with Kounis syndrome can present with dyspnea, angioedema, pruritis, urticaria, gastrointestinal distress and hemodynamic instability. [sjrhem.ca]

  He developed constricting chest discomfort associated with dyspnea, sweating and hypotension. [revportcardiol.org]

  Despite this, a history of persistent chest discomfort, dyspnea, ST segments changes on ECG, and elevated troponin necessitates further testing, including coronary angiography. [amjcaserep.com]

  Case: A 59 year old man with a history of CAD status post RCA stent and COPD presented with progressively worsening chest pain, dyspnea, and hives after a bee sting. Electrocardiogram demonstrated an inferior STEMI. [jacc.org]

• Vomiting

  […] words: Kounis syndrome, Coreopsis atramentaria, acute coronary syndrome Case report A 27-year-old man, with no cardiovascular risk factors and a history of mild persistent asthma, nasal polyps and aspirin allergy, was transferred with dizziness and vomiting [signavitae.com]

  Relevant Negative History • No H/O Palpitations, Pedal edema, Abdominal distension • No H/O dysphagia, vomiting, loose stools, LGI bleed, constipation, obstipation • No H/O oliguria, dysuria • No H/O LOC, Seizures • No H/O suggestive of Rheumatologic [slideshare.net]

  Central Illustration Abstract We describe the case of a 15-year-old female patient with Peutz-Jeghers syndrome who presented with vomiting and abdominal pain secondary to ileoileal invagination. [jacc.org]

  Clinical symptoms Acute chest pain Chest discomfort Difficulty in swallowing Dyspnea Faintness Headache Malaise Nausea Pruritus Syncope Vomiting Urticaria Clinical signs Bradycardia or tachycardia Cardiorespiratory arrest Cold extremities Diaphoresis [medscape.com]

  Presenting symptoms can be largely broad, ranging from minor symptoms such as flushing, nausea, vomiting, chest pain, and chest discomfort to major events such as hemodynamic instability and sudden death [2]. [cureus.com]

• Nausea

  Clinical presentation ranges from non-specific symptoms such as dizziness and nausea to myocardial infarction. Many cases of KS were reported after the use of iodinated contrast media, mainly during radiological procedures. [casereports.bmj.com]

  […] symptoms (rash, urticaria, angioedema), breathing (dyspnoea, wheezing, hoarseness, stridor) and/or gastrointestinal (abdominal pain, nausea, vomiting). [signavitae.com]

  Shortly afterward, she experienced sudden shortness of breath and nausea. [jaci-inpractice.org]

  Clinical symptoms Acute chest pain Chest discomfort Difficulty in swallowing Dyspnea Faintness Headache Malaise Nausea Pruritus Syncope Vomiting Urticaria Clinical signs Bradycardia or tachycardia Cardiorespiratory arrest Cold extremities Diaphoresis [medscape.com]

  Presenting symptoms can be largely broad, ranging from minor symptoms such as flushing, nausea, vomiting, chest pain, and chest discomfort to major events such as hemodynamic instability and sudden death [2]. [cureus.com]

• Lip Swelling

  Our patient's symtoms of tongue and lip swelling with hives worsening after penacillin use complicated by cardiac arrest prompted a diagnosis of Type 1 Kounis syndrome. [journal.chestnet.org]

• Thrombosis

  The condition has three variants; type 1 – coronary spasm; type 2 – coronary thrombosis; and type 3 variant includes patients with coronary thrombosis (including stent thrombosis), in whom aspirated thrombus specimens stained with haematoxylin-eosin and [internationaljournalofcardiology.com]

  It can cause local hypersensitivity phenomena which can lead to stent thrombosis in the worst case [2]. [johnsonfrancis.org]

  Log In or Register to continue Dec 19, 2018 | Posted by in CARDIOLOGY | Comments Off on An uncommon but important cause of stent thrombosis: Kounis syndrome [thoracickey.com]

  While Type III is seen with hypersensitivity reactions leading to in-stent thrombosis. [jacc.org]

• Chest Pain

  His chest pain improved gradually in the ED and his first electrocardiogram (ECG) was normal. Troponin I was within the normal range. After admission he remained free of chest pain. [ejcrim.com]

  Electrocardiogram during chest pain Figure 2. Electrocardiogram without chest pain Figure 3. Coronarography; RCA — right coronary artery; LAD — left anterior descending artery; CX — circumflex artery [journals.viamedica.pl]

  However, ischemic chest pain continued attacking in the morning during hospitalization. [bmccardiovascdisord.biomedcentral.com]

  However the subtle ST- changes and anginal chest pain prompted suspicion for acute coronary syndrome (ACS) then confirmed by a positive troponin. [ahajournals.org]

  Contents 1 Background 2 Clinical Features 3 Differential Diagnosis 3.1 Chest pain 3.1.1 Critical 3.1.2 Emergent 3.1.3 Nonemergent 3.2 Elevated Troponin 3.2.1 True Positive 3.2.2 False (Non-CAD) Positives 4 Evaluation 4.1 Workup 4.2 Diagnosis 5 Management [wikem.org]

• Hypotension

  Vital signs on presentation are significant for hypotension with blood pressure of 69/30 mm Hg, sinus tachycardia to 110 bpm and hypoxia with SatO2 88% on room air. [ahajournals.org]

  Prolonged hypotension is another pathogenic mechanism for acute coronary syndrome, especially in patients with compromised cardiovascular system. [eusem.org]

  Approximately 6 hours after the operation, bradycardia and hypotension suddenly emerged, with ST elevation in the electrocardiogram. ACS was suspected and coronary angiography was immediately performed. [pure.fujita-hu.ac.jp]

  While still on the table in the electrophysiology lab, the patient developed hypotension and the monitor showed ST elevations in the inferior leads, as shown in Figure 1. [cureus.com]

  Five minutes after receiving a vial of intravenous metamizole, she started to show generalized urticaria, chest pain, and intense dyspnea, accompanied by severe hypotension (systolic blood pressure: 70mmHg). [revespcardiol.org]

• Tachycardia

  The ECG shows sinus tachycardia without evidence of other abnormalities. Image source: Burns, Ed. “Sinus Tachycardia • LITFL • ECG Library Diagnosis.” Life in the Fast Lane • LITFL, 7 Feb. 2021, litfl.com/sinus-tachycardia-ecg-library/. [sjrhem.ca]

  Clinical symptoms Acute chest pain Chest discomfort Difficulty in swallowing Dyspnea Faintness Headache Malaise Nausea Pruritus Syncope Vomiting Urticaria Clinical signs Bradycardia or tachycardia Cardiorespiratory arrest Cold extremities Diaphoresis [medscape.com]

  • NO TACHYCARDIA IN INITIAL ECG ( HR<100/min ) • Second dose of Adrenaline didn’t worsen it, rather ECG showed regression of ischemic changes. • Half life of adrenaline. 18. • On Discharging, • Patient BP was 90/60 mm Hg • No tachycardia • No Tachypnea [slideshare.net]

  Vital signs on presentation are significant for hypotension with blood pressure of 69/30 mm Hg, sinus tachycardia to 110 bpm and hypoxia with SatO2 88% on room air. [ahajournals.org]

  Physical exam was significant for tachycardia, extensive envenomation and urticaria. Initial electrocardiogram (ECG) revealed no evidence of active ischemia. [onlinejacc.org]

• Palpitations

  We report the case of 57-year-old man, with hypertension and history of allergy, referred for facial rash and palpitations appeared after consumption of canned tuna fish. [tandfonline.com]

  Kounis syndrome Hypersensitivity myocarditis Cardiac symptoms Acute chest pain + - Chest discomfort + + Dyspnea + + Palpitations + + Sudden death + + Cardiac signs Elevated JVP + + Irregular pulse + + Gallop rhythm + + Electrocardiographic signs Atrioventricular [medscape.com]

  Case Report We present the case of a 41-year-old woman with no cardiovascular risk factors who was admitted at our emergency department with flushing, palpitation, dyspnea, and chest pain 15 min after the first dose of inactivated CoronaVac (Sinovac Life [jem-journal.com]

  Relevant Negative History • No H/O Palpitations, Pedal edema, Abdominal distension • No H/O dysphagia, vomiting, loose stools, LGI bleed, constipation, obstipation • No H/O oliguria, dysuria • No H/O LOC, Seizures • No H/O suggestive of Rheumatologic [slideshare.net]

  A few minutes after administration of the drug, the patient had sudden chest discomfort and pain in the left arm, shortness of breath, sweating and palpitations, generalized erythema and cutaneous rashes that justified admission to Emergency Room. [clinmedjournals.org]

• Pruritus

  Abstract Consider this diagnosis in any patient with suspected/proven acute coronary syndrome and concurrent allergic manifestations, eg, pruritus, hives, wheezing Keywords Acute Coronary Syndrome Systemic MASTOCYTOSIS Coronary Artery Aneurysm Ventricular [link.springer.com]

  He also reported numerous episodes of feeling faint, generalized flushing and skin pruritus that led to repeated assessments at the emergency department. [cmaj.ca]

  Treatment for anaphylaxis was initiated with intravenous hydrocortisone, diphenhydramine, and famotidine with improvement in pruritus, dyspnea, and chest discomfort. The patient's blood pressure also improved to 120/60 mm Hg. [ncbi.nlm.nih.gov]

  The most commonly reported adverse events were periorbital oedema (1,339), pruritus (1,223), orbital oedema (828), urticarial (594) and rash (532)7. [npra.gov.my]

  Clinical symptoms Acute chest pain Chest discomfort Difficulty in swallowing Dyspnea Faintness Headache Malaise Nausea Pruritus Syncope Vomiting Urticaria Clinical signs Bradycardia or tachycardia Cardiorespiratory arrest Cold extremities Diaphoresis [medscape.com]

• Sweating

  He developed constricting chest discomfort associated with dyspnea, sweating and hypotension. [revportcardiol.org]

  Suddenly he presented exacerbation of the cutaneous rash, accompanied by non-irradiated oppressive chest pain and profuse sweating that ceased after the administration of IV corticosteroids. [journals.viamedica.pl]

  However, the patient developed chest pain with sweating 10 minutes after injection of anisodamine. [dovepress.com]

  After a serious attack of 15 minutes with heavy sweating at 2:00, she was sent to our hospital. On admission, her blood pressure was 150/100 mmHg, heart rate was 76 beat per minute, physical examination revealed no abnormalities. [bmccardiovascdisord.biomedcentral.com]

  Difficulty in swallowing Dyspnea Faintness Headache Malaise Nausea Pruritus Syncope Vomiting Urticaria Clinical signs Bradycardia or tachycardia Cardiorespiratory arrest Cold extremities Diaphoresis Hypotension Pallor Palpitations Skin rash Sudden death Sweating [medscape.com]

• Skin Rash

  The skin rash improved after the initiation of steroid and anti-histamine agent, and no thrombotic events occurred thereafter. The authors presumed that clopidogrel might have been responsible for the allergic manifestations. [thoracickey.com]

  rash after eating a tuna sandwich. [journals.viamedica.pl]

  During the tramadol infusion, the patient had a reaction characterized by generalized skin rash. Moreover, high blood pressure (blood pressure, 140/105 mm Hg) was recorded, and headache developed. [jacc.org]

  rash Sudden death Sweating Electrocardiographic signs Atrial fibrillation Bigeminal rhythm Nodal rhythm Sinus bradycardia Sinus tachycardia ST segment depression or elevation T-wave flattening and/or inversion QRS complex prolongation QT segment prolongation [medscape.com]

  Allergic skin reactions occurred in 16 patients, including skin rash (15 patients) and itching (eight patients). [frontiersin.org]

• Skin Lesion

  lesion (urticaria, angio-oedema, mucosal involvement) or hypotension. [7] The diagnosis of the syndrome is made primarily via symptoms and signs, electrocardiographic and laboratory features, and echo-cardiographic and angiographic changes in patients [scielo.org.za]

  Urticarial skin lesions appeared, scattered on the trunk and extremities, and syncope ensued with loss of consciousness. Physical examination demonstrated a heart rate of 30 bpm and severe hypotension (60/40 mmHg). [signavitae.com]

• Hyperactivity

  Successful treatment of refractory vasospastic angina with corticosteroids: Coronary arterial hyperactivity caused by local inflammation. Circ J. 2004;68: 17‐ 22. [37] Cepeda PR, Herrejón EP, Aguirregabiria MMR. Síndrome de Kounis. [knepublishing.com]

  Successful treatment of refractory vasospastic angina with corticosteroids: coronary arterial hyperactivity caused by local inflammation? Circ J 2004;68:17-22. Ridella M, Bagdure S, Nugent K, et al. [cdt.amegroups.com]

  Takagi S, Goto Y, Hirose E, Successful treatment of refractory vaso-spastic angina with corticosteroids: Coronary arterial hyperactivity caused by local inflammation?: Circ J, 2004; 68(1); 17-22 18.. [amjcaserep.com]

  Successful treatment of refractory vasospastic angina with corticosteroids: coronary arterial hyperactivity caused by local inflammation?. Circ J. 2004 Jan;68(1):17-22. [revistas.unicartagena.edu.co]

• Headache

  Moreover, high blood pressure (blood pressure, 140/105 mm Hg) was recorded, and headache developed. A few minutes later, orthopnea and dyspnea occurred in association with widespread pulmonary rales, suggestive of acute pulmonary edema. [jacc.org]

  Clinical symptoms Acute chest pain Chest discomfort Difficulty in swallowing Dyspnea Faintness Headache Malaise Nausea Pruritus Syncope Vomiting Urticaria Clinical signs Bradycardia or tachycardia Cardiorespiratory arrest Cold extremities Diaphoresis [medscape.com]

  […] cholinergic urticaria, exercise-induced bronchospasm, and rhinitis.[1] In a report,[2] the authors described a 26-year-old male with 3-year history of exercise-induced rash accompanied by flushing, feeling unwell and warm, eyelid angioedema, pruritus, and headache [jpharmacol.com]

  Clinical effects usually occur within two hours of ethanol ingestion and include; headache, flushing of the face, neck, and trunk, Nausea and vomiting, tachycardia, palpitations, chest pain, dyspnea, marked apprehensiveness, rarely, hypotension, cardiac [signavitae.com]

Contents 1 Background 2 Clinical Features 3 Differential Diagnosis 3.1 Chest pain 3.1.1 Critical 3.1.2 Emergent 3.1.3 Nonemergent 3.2 Elevated Troponin 3.2.1 True Positive 3.2.2 False (Non-CAD) Positives 4 Evaluation 4.1 Workup 4.2 Diagnosis 5 Management [wikem.org]

Allergological workup is essential for an accurate diagnosis and to explore cross-reactivity between cefazolin and other beta-lactams. [karger.com]

A workup for allergic acute coronary syndrome was done. Tryptase levels were raised, and total IGE was 1167.5 IU/ml. She improved symptomatically, and there was complete ST resolution by day 3. [joicc.org]

"International expert consensus document on takotsubo syndrome (part II): diagnostic workup, outcome, and management". Eur Heart J 2018;39:22: 2047-2062. 10. Margonato D., Abete R., Di Giovine G., et al. [jacc.org]

In some cases, it might be recommended to do an allergy workup to characterize food, drug, or insect bite allergies to prevent future events and to identify the culprit agent. [mdpi.com]

• ST Elevation

  In this case series, we describe three variable case presentations of anaphylactic ST elevations, which include ST-elevation myocardial infarction (MI) in the presence of underlying coronary artery disease and ST-elevation MI without underlying coronary [ncbi.nlm.nih.gov]

  Top ECG showing ST elevation in inferior leads with reciprocal changes. [oatext.com]

  Gradually, the chest pain improved, and ECG showed good resolution of ST segment elevation. [ejcrim.com]

  In this patient cohort (N=235,420), 2616 patients experienced ACS and were identified as having KS (1.1% overall; 0.2% unstable angina, 0.2% ST-elevation myocardial infarction, and 0.7% non-ST-elevation myocardial infarction). [pulmonologyadvisor.com]

  ECG showed atrial fibrillation with uncontrolled ventricular response together with marked ST elevation in aVR (4,02 mm) and V1 ((2,14 mm). Greater ST elevation in aVR than in V1 usually indicates LMCA lesion. [eusem.org]

• Ventricular Bigeminy

  bigeminy and nonsustained ventricular tachycardia at 13:20 and 13:42. [bmccardiovascdisord.biomedcentral.com]

• Electrocardiogram Change

  Electrocardiogram shows changes in ST segment in precordial leads, ST elevation in V2, V3, and V4. aVF indicates augmented vector foot; aVL, augmented vector left; aVR, augmented vector right. [journals.lww.com]

  His case was considered as myocardial infarction due to an allergic reaction because of the following reasons: symptoms of chest pain, electrocardiogram changes of ST-segment elevation in inferior leads and A-block, diffuse right coronary spasm after [annsaudimed.net]

  Conclusion When electrocardiogram changes suggesting ACS occur during general anesthesia, it is necessary to take KS into consideration as a differential diagnosis. [jaclinicalreports.springeropen.com]

• Abnormal ECG

  An ECG showed a left ventricular ejection fraction of 70%, with no wall motion abnormalities. As a result, we made a diagnosis of type I Kounis syndrome. [cmaj.ca]

  Echocardiography showed regional wall motion abnormality in the inferior left ventricular wall. [bmccardiovascdisord.biomedcentral.com]

Until now, guidelines for the treatment of KS are lacking and most of the recommendations published on the efficacy and safety of the treatment is based on individual case reports. [jmedicalcasereports.biomedcentral.com]

Treatment of Kounis syndrome.. Int J Cardiol., 143 (2010), pp. 223-226 [revespcardiol.org]

In addition to treatment of ACS, attention must also be given to treatment of the underlying allergic process. [onlinejacc.org]

We entirely agree with the authors of this report1 that there is no consensus on treatment for Kounis syndrome, and most of the data on it are from case reports. [revportcardiol.org]

In the long term and after the acute phase, the prognosis is excellent. Conflict of interest: none declared Figure 1. Electrocardiogram during chest pain Figure 2. Electrocardiogram without chest pain Figure 3. [journals.viamedica.pl]

Early recognition and intervention have a great effect on prognosis. [ncbi.nlm.nih.gov]

Treatment and prognosis of NSAIDs-induced Kounis syndrome. [frontiersin.org]

Circulatory management that considers both anaphylaxis and coronary lesions is crucial to improve prognosis in this syndrome. [jcvaonline.com]

Anisakis simplex: a new etiological agent of Kounis síndrome. Int J Cardiol 2013; 167: e187-e189. Zlojtro M, Roginic S, Nikolic-Heitzler V, Babic Z, Kaliterna DM, et al. [austinpublishinggroup.com]

Etiology of Kounis Syndrome A variety of drugs, environmental exposures, foods, and other conditions are the main triggers of Kounis syndrome (Table 1). [tmsforacure.org]

Br J Clin Pract. 1991; 45(2): 121-128 [First complete description of the pathophysiology, etiology and clinical symptomatology of ‘allergic angina’ syndrome.] Nikolaidis LA, Kounis NG, Gradman AH. [litfl.com]

CONCLUSIONS: Allergic myocardial infarction is a rare cause of myocardial infarction leading to cardiac arrest that needs to considered when a clear etiology of myocardial infarction cannot be determined as seen in our patient. [journal.chestnet.org]

An unusual etiology of Kounis syndrome; warble fly. Indian Heart J 2013;65:358-9. 23. Cross B, Choudhury TR, Hindle M, Galasko G. Wasp sting induced STEMI with complete coronary artery occlusion: a case of Kounis syndrome. [mattioli1885journals.com]

Kounis syndrome: a review article on epidemiology, diagnostic findings, management and complications of allergic acute coronary syndrome. Int J Cardiol 2017; 232: 1–4. [cambridge.org]

Epidemiology of acute coronary syndrome co-existent with allergic/hypersensitivity/anaphylactic reactions (Kounis syndrome) in the United States: A nationwide inpatient analysis [published online June 8, 2019]. [pulmonologyadvisor.com]

Kounis syndrome: A review article on epidemiology, diagnostic findings, management and complications of allergic acute coronary syndrome. Int J Cardiol. 2017; 232: 1-4 Yasue H Touyama M Kato H et al. [jcvaonline.com]

Biteker Medicine, Biology Expert review of clinical immunology 2010 The clinical aspects, diagnosis, pathogenesis, incidence and epidemiology, related conditions and therapeutic management of this important syndrome are discussed. [semanticscholar.org]

The epidemiology remains scarce, and thus the prevalence is not entirely known as it is often missed or under diagnosed (Kounis, 2013; Kounis 2016). [sjrhem.ca]

Br J Clin Pract. 1991; 45(2): 121-128 [First complete description of the pathophysiology, etiology and clinical symptomatology of ‘allergic angina’ syndrome.] Nikolaidis LA, Kounis NG, Gradman AH. [litfl.com]

Inflammatory mediators such as histamine constitute the pathophysiologic basis of Kounis hypersensitivity-associated acute coronary syndrome. [tandfonline.com]

University School of Medicine, Patras, Greece Kounis Syndrome is defined as a hypersensitivity coronary disorder constituted by the association of an acute coronary syndrome with a hypersensitivity, allergic, anaphylactic or anaphylactoid reaction, in a pathophysiologic [minervamedica.it]

The pathophysiology is thought to be mediated by the induction of inflammatory cytokines, after an allergic insult that potentiates coronary vasospasm, plaque rupture or in-stent thrombosis. [jacc.org]

However, these authors did not elaborate in the mechanism of action of glucocorticoids in preventing the recurrent and permanent AF. [academic.oup.com]

Therefore, does 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 showing a novel way towards our effort to prevent acute coronary [pubmed.ncbi.nlm.nih.gov]

Once the allergic component is identified, desensitization measures should be employed if possible to prevent such events in the future. [cdt.amegroups.com]

Prompt treatment of the allergic reaction can prevent further fatalities and adverse cardiac outcomes. [smrj.scholasticahq.com]