Letter to the EditorDrug eluting stent-induced Kounis syndrome
Introduction
Kounis syndrome (KS) [1] is the concurrence of acute coronary syndrome with hypersensitivity and anaphylactic or anaphylactoid reactions. This syndrome was firstly described in 1991 [2], but only 1998 Braunwald [3] noted that vaso spastic angina can be induced by “allergic reactions with mediators such as histamine or leukotrienes”. Moreover, hypersensitivity reactions to components of DES which ,via intracoronary mast cell activation, can induce destabilization of the plaque with consequent inflammation and thrombosis have been reported [4], [5]. We report a case of acute myocardial infarction, due to stent thrombosis following an acute allergic reaction.
Section snippets
Case report
A 50-year-old male was referred by his general practitioner for chest pain which was started two hours before presentation. He had a family history of coronary heart disease, hypercholesterolemia and diabetes; was also allergic to larvae of fly carvaria. During examination the pain had been resolved; the blood pressure level was 125/75 mmHg, pulse rate was 78/min and regular; findings on cardiovascular, respiratory, abdominal and neurological examination were normal. ECG and transthoracic
Discussion
KS [1] is the concurrence of acute coronary syndromes (ACS) with conditions associated with mast cells activation.
The main mechanisms are coronary artery spasm and/or atheroma erosion or rupture with consequent thrombosis. These are also at the base of the classification of KS in two variants [6]: Type I (coronary spasm) in patients with normal coronaries that represent a manifestation of endothelial dysfunction and Type II (coronary thrombosis) in patient with quiescent atherosclerosis. In the
Acknowledgement
The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [14].
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2016, International Journal of CardiologyCitation Excerpt :In KS, inflammatory mediators cause a spastic contraction of coronary smooth muscle cells [3]. Mast cells [4], eosinophils and lymphocytes [5] are usually found in histological reports. However, the exact pathophysiologic mechanism underlying this syndrome remains unclear.
Kounis Syndrome: An analysis of spontaneous reports from international pharmacovigilance database
2016, International Journal of CardiologyCitation Excerpt :The same inflammatory mediators can cause a spastic reaction of coronary smooth muscle cells [6] and mast cells [7]. Eosinophils and lymphocytes [8] are found in histological reports. The clinical manifestations of the syndrome focus on typical cardiac signs and symptoms such as chest pain and electrocardiographic alterations in ST segment or T waves or any degree of hearth block and other arrhythmias; in myocardial infarctions the elevation of cardiac enzymes is also observed.
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