Cihan ÖRÇEN

Kounis Sendromu

Kounis sendromu alerji, hipersensitivite, anafilaksi veya anafilaktoid durumlar ile birlikte akut koroner sendromun eş zamanlı olarak meydana gelmesi olarak tanımlanmaktadır. Patofizyolojide ana enflamatuar hücreler olan mast hücrelerinin degranulasyonuyla başta histamin olmak üzere çeşitli mediatörlerin salınımı rol almaktadır. Klinik semptomlar ve bulgular alerjik reaksiyonların eşlik ettiği kardiyak semptomlar ile birliktedir. Sendromun üç farklı varyantı tanımlanmış olup, tanıda en önemli nokta öykü, klinik ve laboratuar bulgularının birlikteliğiyle bu sendromdan şüphelenmektir. Tedavi protokolü kardiyak ve alerjik semptomların eş zamanlı olarak tedavi edilmesini gerektirmektedir.

Kounis Syndrome

Kounis syndrome is defined as the concurrent occurrence of acute coronary syndrome with allergy, hypersensitivity, anaphylaxis or anaphylactoid conditions. The degranulation of mast cells, which are the main inflammatory cells, and the release of various mediators, mainly histamine, play a role in the pathophysiology. Clinical symptoms and signs are associated with cardiac symptoms accompanied by allergic reactions. Three different variants of the syndrome have been defined and the most important point in diagnosis is to suspect this syndrome with the combination of history, clinical and laboratory findings.

PDF

___

1. Kounis NG. Coronary hyper sensitivity disorder: the Kounis syndrome. ClinTher. 2013;35:563–71.
2. Kounis NG, Zavras GM. Histamine- induced coronary artery spasm: the concept of allergic angina. Br J ClinPract. 1991 Summer;45(2):121- 8. PMID: 1793697.
3. Fassio F, Losappio L, Antolin-Amerigo D, Peveri S, Pala G, Preziosi D, et al. Kounissyndrome: a concise review with focus on management. Eur J InternMed. 2016;30:7– 10.
4. N.G. Kounis, A. Mazarakis, G. Tsigkas, S. Giannopoulos, J. Goudevenos, Kounis syndrome: a new twist on an old disease,Futur. Cardiol. 7 (2011) 805–824.
5. Desai R, Parekh T, Patel U, Fong HK, Samani S, Patel C,et al. Epidemiology ofacute coronary syndrome co-existent with allergic/hyper sensitivity/anaphylactic reactions (Kounis syndrome) in the United States: A nation wide in patient analysis. Int J Cardiol. 2019 Oct 1;292:35-38.
6. N.G. Kounis, Kounis syndrome (allergic angina and allergic myocardial infarction): a natural paradigm? Int. J. Cardiol. 110 (2006) 7–14.
7. Mikelis CM, Simaan M, Ando K, Fukuhara S, Sakurai A, Amornphimoltham P, et al. Rho A and ROCK mediate histamine- induced vascular leakage and anaphylactic shock. NatCommun. 2015;6:6725.
8. Brown SGA, Kemp SF, Lieberman PL. Anaphylaxis. In: Adkinson NF, Bochner BS, editors. Middleton’sallergy: principles and practice. 8th ed. Philadelphia: Elsevier; 2014. p. 1237–59.
9. Johnson JL, Jackson CL, Angelini GD, George SJ. Activation of matrix degrading metallo proteinases bymast cell proteases in atherosclerotic plaques. Arterioscler Thromb Vasc Biol.1998;18:1707–1715.
10. Kounis NG, Tsigkas G, Almpanis G, Kouni SN, Kounis GN, Mazarakis A. Anaphylaxis- induced hyper fibrinogenolysis and the risk of Kounis syndrome: the dualaction of tryptase. Am J EmergMed. 2011;29: 1229–1230.
11. Carl-McGrath S, Gräntzdörffer I,Lendeckel U, Ebert MP, Röcken C. Angiotensin II generating enzymes, angiotensin converting enzyme (ACE) and mast cell chymase (CMA1), in gastric inflammation may be regulated by H. pylori and associated cytokines. Pathology. 2009;41:419–42.
12. Allen SP, Dashwood MR, Chester AH, Tadjkarimi S, Collins M, Piper PJ,et al. Influence of atherosclerosis on the vascularre activity of isolated human epicardial coronary arteries to leukotriene C4. Cardioscience. 1993;4:47–54.
13. Marone G, Bova M, Detoraki A, OnoratiAM, Rossi FW, Spadaro G. The human heart as a shock organ in anaphylaxis. NovartisFoundSymp. 2004; 257:133–499
14. Kaartinen M, Penttila A, Kovanen PT. Accumulation of activated mast cells in the shoulder region of human coronary atheroma, the prediction site of atheromatous rupture. Circulation. 1994;90:1669 –1678.
15. Kounis NG. Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and the rapeutic management. ClinChemLabMed. 2016;54:1545–1559.
16. Triggiani M, Montagni M, Parente R, Ridolo E. Anaphylaxis and cardiovascular diseases: a dangerous liaison. CurrOpinAllergy ClinImmunol. 2014 Aug;14(4):309-15.
17. Hamera L, Khishfe BF. Kounis syndrome and ziprasidone. Am J EmergMed. 2017;35:493– 494.
18. Reza Karimlu M, Alavi-Moghaddam A, Rafizadeh O, Azizpour A, Khaheshi I. Acute extensive anterior ST elevation myocardial infarction following beesting: a rare report of Kounis syndrome in LAD territory. CardiovascDiagnTher. 2016;6: 466–468.
19. Michas G, Stougiannos P, Thomopoulos T, Grigoriou K, Blazakis G, Kaplanis I, et al. Acute anterior myocardialinfarctiondue to stent thrombosis after mushroom consumption. A case of Kounistype III syndrome. Hellenic J Cardiol. 2017;58:378–380.
20. Patanè S, Marte F, Di Bella G, ChiofaloS, Currò A, Coglitore S. Acute myocardial infarction and Kounis syndrome. Int J Cardiol. 2009;134:e45- 6.
21. Karabay CY, Can MM, Tanboğa IH, Ahmet G, Bitigen A, Serebruany V. Recurrent acute stent thrombosis due to allergic reaction secondary to clopidogrel therapy. Am J Ther. 2011;18:e119-22.
22. Goto K, Kasama S, Sato M, Kurabayashi M. Myocardial scintigraphic evidence of Kounis syndrome: what is the aetiology of acute coronary syndrome? EurHeart J. 2016 Apr 7;37(14):1157.
23. Okur A, Kantarci M, Karaca L, Ogul H, Aköz A, Kızrak Y, etal. The utility of cardiac magnetic resonance imaging in Kounis syndrome. PostepyKardiolInterwencyjnej 2015;11:218–23.
24. Cevik C, Nugent K, Shome GP, Kounis NG. Treatment of Kounis syndrome. Int J Cardiol. 2010;143:223–6.
25. Krajčová A, Matoušek V, Duška F. Mechanism of paracetamol-induced hypotension in critically ill patients: a prospective observational cross-over study. AustCritCare 2013;26:136–41.