Letter to the Editor
Serum tryptase levels in acute coronary syndromes with ST elevation

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Abstract

A patient with severe coronary disease, who underwent inguinal hernia repair, suffered a cardiovascular collapse after anaesthetic induction and died. He had Kounis syndrome, which is the concurrence of acute coronary syndrome (ACS) with conditions associated with mast cell activation. We measured the serum tryptase level in this patient and in a group of ten other patients admitted to hospital with the diagnosis of ACS with ST elevation in order to determine the origin of these events.

Section snippets

Case report

A man of 62 yr underwent general anaesthesia for inguinal hernia repair. He had a history of a congenital encephalopathy with moderate–severe mental deficiency. He had had an anteroseptal infarction and the coronary arteriography, after an episode of unstable angina, showed an atherosclerotic coronary disease affecting three vessels. In addition, an ejection fraction of 44% and a moderate–severe incompetent tricuspid valve were observed. As he remained stable with clinical treatment, coronary

Discussion

The high level of tryptase found in the patient undergoing inguinal hernia repair indicated that a mast cell activation–degranulation had occurred. Mertes et al. [4] have suggested that a tryptase value higher than 25 μg L 1 is a good indicator of anaphylactic reaction. We cannot confirm that another acute myocardial infarction occurred but the mediators released during the acute allergic episode induced an ACS with ST elevation, a fact that together with the development of a large thrombus

References (7)

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