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]

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]

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

• Intravenous Administration

  Intramuscular epinephrine is preferred to intravenous administration due to risk of ischemia and vasospasm. Given the confluence of two distinct life-threatening conditions, clinicians must remain cognizant of this severe overlap syndrome. [jacc.org]

  Acute efficacy and safety of intravenous administration of nicorandil in patients with acute heart failure syndromes: Usefulness of noninvasive echocardiographic hemodynamic evaluation. [jcvaonline.com]

  Treatment for anaphylaxis was started, with intravenous administration of hydrocortisone, diphenhydramine and bronchodilators, followed by improvement in cutaneous rashes, dyspnea, erythema and chest discomfort. 2D echocardiography did not reveal any [clinmedjournals.org]

  After continuous 48-hour intravenous administration of nitroglycerin, as well as added dose of mononitrate and nifedipine before night sleep, chest pain seemed to calm down, she kept symptomless for 5 days and discharged. [bmccardiovascdisord.biomedcentral.com]

  "kounis syndrome induced by intravenous administration 0f piperacillin/tazobectam". International journal of cardiology. 2012; 155:e42-e44. [annsaudimed.net]

• Chest Discomfort

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

  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]

  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 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]

  […] 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]

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

  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]

  After the drug administration, the patient presented dyspnea, cyanosis, and hemoptysis. There was suspicion of anaphylactic shock, which was treated, but there was no improvement in the clinical condition. [ijcscardiol.org]

  Two hours later, he developed chest pain, dyspnea and diaphoresis. Repeat ECG revealed ST elevation in leads II, III, and aVF with reciprocal changes. He received aspirin and heparin and was taken for coronary angiography. [onlinejacc.org]

• Aspiration

  After an aspiration thrombectomy, a total of 3 synergy drug-eluting stents (DES) were implanted in the proximal and distal segment of the RCA. [thoracickey.com]

  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]

  He had 80% occlusion of the right coronary artery by thrombus, treated with aspiration thrombectomy and stent placement, as well as occlusion of the distal right posterior descending artery. [onlinejacc.org]

  Harvesting of intrastent thrombus together with histological examination of aspirated material and staining for eosinophils and mast cells should be undertaken. [en.wikipedia.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]

  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]

  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]

  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]

  It can manifest with a constellation of symptoms, but common manifestations include urticaria, shortness of breath, vomiting, lightheadedness, and low blood pressure. [joicc.org]

• 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]

  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]

  This condition can be accompanied by systemic manifestations such as abdominal pain, nausea, vomiting and diarrhea.[8] The humanized monoclonal IgG anti-IgE antibody omalizumab that binds specifically to circulating IgE molecules and interrupting the [jpharmacol.com]

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

• Thrombosis

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

  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]

  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

  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]

  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]

  Cocaine-associated chest pain Mediastinitis Myocardial rupture Myocarditis Pancreatitis Pericarditis Pneumothorax Nonemergent Aortic stenosis Arthritis Asthma exacerbation Biliary colic Costochondritis Esophageal spasm Gastroesophageal reflux disease [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]

  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]

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

  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

  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]

  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]

  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]

  They also induce tachycardia, dysfunctional ventricular contractility and blockade of atrioventricular conduction. [eusem.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]

  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]

  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]

  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]

• Flushing

  One minute after undergoing CTA, he developed shortness of breath, wheezing, flushing, and then loss of consciousness, with heart rate and blood pressure dropping to 50 bpm and 60/45 mm Hg, respectively, within 5 minutes. [jamanetwork.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]

  Her facial flushing diminished, and her BP increased to 102/78 mm Hg. A second troponin T ultrasensitive determination was 1728 pg/mL. [journals.lww.com]

  Two or more of the following that occur rapidly after exposure to a likely allergen for that patient (minutes to several hours) A) Involvement of the skin-mucosal tissue (eg, generalized urticaria, itch-flush, swollen lips-tongue-uvula) B) Respiratory [ekjm.org]

  […] allergies are exercise-induced anaphylaxis (EIA), food-dependent EIA 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 [jpharmacol.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]

• 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]

• Dizziness

  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]

  We report a case of a 27 year old patient with a previous history of mild persistent asthma, nasal polyps and aspirin allergy that arrived to the Emergency Department with dizziness and temor after consuming beer at a party. [signavitae.com]

  We presented a 58-year-old man with dyspnea, chest pain, dizziness, and itchiness 30 minutes following sodium diclofenac ingestion. His physical examination was remarkable for shock with hypoxia and features of anaphylactic reaction. [thieme-connect.com]

  He presented to our emergency department 30 minutes later with dizziness, pruritus, warmth, flushing, and dyspnea associated with retrosternal oppression graded 7/10 on a pain scale. [jmedicalcasereports.biomedcentral.com]

• Giddiness

  Diclofenac I.M for pain relief • After 10-15 mins of IM Injection, Patient developed • Chest discomfort – retrosternal; tightness; non-radiating • Urticarial rashes all over the body • Giddiness • IM Adrenaline 0.5cc given and IV Fluids started • After [slideshare.net]

• Vertigo

  Case presentation Case 1 A 56 year-old male without known cardiac risk factors presented to the emergency room complaining of retrosternal chest pain radiating to his back with excessive sweating, vertigo and mild dyspnea for about 30 minutes. [bmccardiovascdisord.biomedcentral.com]

• Altered Mental Status

  At presentation, he had an altered mental status with a Glasgow Coma Scale (GCS) of 14/15 and had generalized urticaria. His vital signs were stable. [jmedicalcasereports.biomedcentral.com]

Should proceed according to standard ACS evaluations Diagnosis Standard ACS workup Serum IgE levels may be elevated Management Primary treatment should focus on cessation of the anaphylactic or allergic event Disposition Admission for monitoring with [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 Anterior Leads

  Fig. 2 Electrocardiogram showing ST elevation in anterior leads with ST depression in inferior wall Full size image Fig. 3 Coronarography showing total mid-left anterior descending artery occlusion (Thrombolysis in Myocardial Infarction Grade Flow 0) [jmedicalcasereports.biomedcentral.com]

  A 12-lead electrocardiogram showed ST elevation in anterior leads, suggestive of hyper acute stage of anterior wall myocardial infarction. The patient was transferred to the intensive cardiac care unit and there the ST elevation disappeared. [wjgnet.com]

• Ventricular Bigeminy

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

The usual treatment of ACS is recommended as an initial treatment, although in type I variant the treatment of the allergic reaction could be enough. [journals.viamedica.pl]

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]

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]

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]

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]

Kounis syndrome has revealed that the same mediators released from the same inflammatory cells are present in acute coronary events of nonallergic etiology. [futuremedicine.com]

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]

Kounis NG: Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management. Clin Chem Lab Med 2016; 54: 1545–1559. [karger.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]

Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management. Clin. Chem. Lab. Med. 2016 Oct 1; 54: 1545-1559 Itoh T. Nakajima Y. Morino Y. Proposed classification for a variant of Kounis syndrome. Clin. Chem. Lab. [internationaljournalofcardiology.com]

Crossref PubMed Scopus (116) Google Scholar ], we believe that the following observations and additions on its pathophysiology and management would be of value. 1. [ejinme.com]

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]

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]

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

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