Letter to the EditorSerum tryptase levels in acute coronary syndromes with ST elevation
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)
- et al.
Serum tryptase levels in acute coronary syndromes
Int J Cardiol
(2005) - et al.
Anaphylactic and anaphylactoid reactions occurring during anaesthesia in France. Seventh epidemiologic survey (January 2001–December 2002)
Ann Fr Anesth Reanim
(2004) Kounis syndrome (allergic angina and allergic myocardial infarction): a natural paradigm?
Int J Cardiol
(2006)
Cited by (12)
Acute Lateral Myocardial Infarction Secondary to Tramadol-Induced Kounis Syndrome
2015, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :The diagnosis is clinical and is based on the identification of signs and symptoms suggestive of an allergic reaction and ECG changes; laboratory, echocardiography, and angiography findings suggestive of a coronary event also should be encountered coinciding in time. As well as laboratory findings indicating cardiac damage, tests specify the possible allergic reactions (serum tryptase, histamine, arachidonic acid derivatives, interleukins, tumor necrosis factor, complement, eosinophilia, and total and specific immunoglobulin E) are the other important analyses used in the diagnosis of Kounis syndrome.9 Serum tryptase is the most abundant secretory granule-derived serine proteinase contained in mast cells, and elevated levels of serum tryptase occur in both anaphylactic and anaphylactoid reactions.
A case of Kounis syndrome associated with transcatheter arterial chemoembolization for hepatocellular carcinoma
2015, Journal of Cardiology CasesCitation Excerpt :Some examinations are helpful to prove simultaneous occurrence of cardiac damage and allergic reaction and support the diagnosis. Laboratory tests such as measurement of serum cardiac enzymes, tryptase [4], and histamine, eosinophil number and total IgE level may be helpful [2]. It was reported that histological analysis of the aspirated thrombi by hematoxylin–eosin and Giemsa staining showed the presence of eosinophils and mast cells [5].
Letter to the editor: Anaphylaxis mediated myocardial infarction in a coronary graft: A new variant of Kounis syndrome (a case report)
2013, International Journal of CardiologyAnaphylaxis in anesthesia
2013, Revista Espanola de Anestesiologia y ReanimacionKounis syndrome type i
2012, Revista Clinica EspanolaKounis syndrome
2012, Medicina Intensiva