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Síndrome de Kounis Online (Kounis´s syndrome)

Por Paulo Leite 04/10/2018

A síndrome de Kounis é definida como a ocorrência concomitante de reação alérgica e síndrome coronariana aguda secundária ao vasoespasmo. Duas variantes foram descritas: tipo I, que ocorre em pacientes com artérias coronárias normais, e tipo II, que ocorre em pacientes com doença ateromatosa da artéria coronária angiograficamente mostrada, nos quais a reação alérgica pode ocorrer e provocar ruptura da placa de ateroma, além de vasoespasmo. Várias condições foram relatadas como capazes de induzir a síndrome de Kounis, incluindo medicamentos, alimentos, picada de mosquito, exposições ambientais. O mecanismo pelo qual esses alérgenos produzem vasoespasmo coronariano é por meio da degranulação de mastócitos e, finalmente, pela liberação de mediadores vasoativos (histamina, leucotrienos, serotonina) e proteases (triptase, quinase). Apesar disso, a síndrome de Kounis continua sendo uma entidade subdiagnosticadaque deveria ser considerada no diagnóstico diferencial de choque cardiogênico. Seria útil aprimorar o seu diagnóstico para descartar a reação alérgica como uma possível causa em todos os pacientes de serviços de emergência que apresentam dor torácica e elevação do segmento ST no eletrocardiograma. O tratamento atual recomendado é a terapia combinada para síndrome coronariana aguda e anafilaxia, tendo em mente que alguns medicamentos usados para tratar a síndrome coronariana podem agravar a reação anafilática e vice-versa.¨

■ Kounis syndrome induced by amoxicillin following vasospatistic coronary event in a 22-year-old patient: a case report

S Pradhan, M Christ, H Trappe

CardiovascDiagnTher 2018, vol 8 (2)? 180-185

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5951989/

■ Síndrome de Kounis, a propósito de um caso.

Méndez-Betancourt, Johan L et al.

Acta méd. Peru, Ene 2018, vol.35, no.1, p.65-70

http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1728-59172018000100011&lng=en&nrm=iso

■ Allergic angina syndrome in anesthesia and diabetes

N G Kounis, I Koniari, G Tzanis et al

Indian J Crit Care MEd 2018, vol 22 (2): 128-129

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842458/

■ Kounis syndrome, a disease to know: case report and review of the literature

E Sciatti, E Vizzardi, D S Cani et al

Monaldi Arch Chest Dis 2018, vol 88 (1): 898

https://www.monaldi-archives.org/index.php/macd/article/view/898/819

■ Síndrome de Kouniso angina alérgica

Villamil-Munovar, Pablo Alejandro and Sanchez-Solanilla, Luis F

Rev. Colomb. Cardiol., Ago 2017, vol.24, no.4, p.382-387

http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-56332017000400382&lng=en&nrm=iso

■ Allergic angina: a new addition to the differential diagnosis and pathophysiology of chest pain

O Culpepper, M Jerger, S Belen et al

JACC 2018, vol 71 (11)

http://www.onlinejacc.org/content/71/11_Supplement/A2185

■ Síndrome de Kounis, el tipo de infarto olvidado?

Lozano-Cruz, Patricia et al.

Rev. Colomb. Cardiol., Abr 2017, vol.24, no.2, p.197-198

http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-56332017000200197&lng=en&nrm=iso

■ Type 1 Kounis syndrome in a patient with idiopathic anaphylaxis

Monica Sandhu, Jason Casselman, Brian Peppers et al

Allergy Rhinol (Providence) 2017 Jun; 8(2): e103–e104

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468754/

■ Early stent thrombosis secondary to food allergic reaction: Kounis syndrome following rice pudding ingestion

GeorgiosTzanis, Maria Bonou, NikolaosMikos et al

World J Cardiol. 2017 Mar 26; 9(3): 283–288

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5368679/

■ Kounis syndrome and systemic mastocytosis in a 52-year-old man having surgery

Marina Lerner, Raveen S. Pal, RozitaBorici-Mazi

CMAJ. 2017 Feb 6; 189(5): E208–E211

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5289872/

■ Type 1 Kounis syndrome in patient with idiopathic analphylaxis

TajdaKeber, Jana Makuc, GregorSekavčnik

Case Rep Cardiol. 2017; 2017: 1089023

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5306988/

■ Thrombotic responses to coronary stents, bioresorbable scaffolds and the Kounis hypersensitivity-associated acute thrombotic syndrome

Nicholas G. Kounis, IoannaKoniari, AnastasiosRoumeliotis et al

J Thorac Dis. 2017 Apr; 9(4): 1155–1164

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418277/

■ Preventing Kounis syndrome by stent implantation: a reciprocal process?

Nicholas G. Kounis, IoannaKoniari, Nicholas Patsouras, George Hahalis

Anatol J Cardiol. 2017 Sep; 18(3): 238

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5689058/

■ Ampicillin/sulbactam-induced Kounis syndrome with cardiogenic shock

Nicholas G. Kounis, IoannaKoniari

Anatol J Cardiol. 2017 Feb; 17(2): 154–155

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5336756/

■ Management of Kounis syndrome: two case reports

MajdiOmri, HajerKraiem, OlfaMejri, MounirNaija, NaoufelChebili

J Med Case Rep. 2017; 11: 145

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440976/

■ In-stent restenosis and thrombosis due to metal hypersensitivity implications for Kounis syndrome

IoannaKoniari, Nicholas G. Kounis, George Hahalis

J Thorac Dis. 2016 Nov; 8(11): 3056–3058

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5179401/

■ Exercise-induced urticarial cholinergic urticarial, and Kounis syndrome

Nicholas G. Kounis, George N. Kounis, George D. Soufras

J PharmacolPharmacother. 2016 Jan-Mar; 7(1): 48–5

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831493/

■ Multiple bee stings resulting in ST elevation myocardial infarction (the Kounis syndrome)

Joseph R. Pelli, Jr., J. Scott Wieters, BahromFirozgary, Timothy Montalvo

Proc (BaylUniv Med Cent) 2016 Jul; 29(3): 298–300.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4900775/

■ Complicações cardíacas em síndrome de Kounis tipo I induzida por metamizol.

Juste, Jose F. Martínez et al

Rev. Bras. Anestesiol., Apr 2016, vol.66, no.2, p.194-196

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942016000200194&lng=en&nrm=iso&tlng=pt

■ Kounis syndrome and systemic mastocytosis in a 52-year-old man having surgery

M Lerner, R S Pal, R Borici-Mazi

CMAJ august 2016

http://www.cmaj.ca/content/early/2016/08/02/cmaj.151314

■ Allergic acute coronary syndrome (Kounis syndrome)

SarfarazMemon, Lovely Chhabra, ShihabMasrur, Matthew W. Parker

Proc (BaylUniv Med Cent) 2015 Jul; 28(3): 358–362

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462222/

■ Allergic angina following wasp sting: Kounis syndrome

Prem Krishna Anandan, Natesh B. Hanumanthappa, Prabhavathi Bhatt et al

Oxf Med Case Reports. 2015 Jun; 2015(6): 306–308

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4584504/

■ Acute myocarditis or the Kounis syndrome: role of cardiac MRI and speckle-tracking echocardiography in diagnosis

OguzKaraca, BeytullahCakal, SinemDenizCakal, Muhsin Turkmen

Res Cardiovasc Med. 2014 Nov; 3(4): e25715.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4347723/

■ A case with repeated recurrent acute coronary syndrome due to pseudoephedrine use: Kounis syndrome

MetinÇeliker, Mustafa Tuncer, Ali Şekeralmaz

Case Rep Med. 2014; 2014: 742905

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4243469/

■ Anaphylactic cardiovascular collapse during hemodialysis: Kounis syndrome in the dialysis room

Andreas Mazarakis, Konstantinos Bardousis, George Almpanis et al

World J Cardiol. 2014 Oct 26; 6(10): 1131–1134

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4209441/

■ The more allergens and atopic patient is exposed to, the easier and quicker analphylactic shock and Kounis syndrome appear: clinical and therapeutic paradoxes

G. Kounis, A. Mazarakis, G. Almpanis, K. Gkouias, G. N. Kounis, G. Tsigkas

J Nat SciBiol Med. 2014 Jul-Dec; 5(2): 240–244.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4121890/

■ Adverse cardiac events to monoclonal antibodies used for cancer therapy: The risk of Kounis syndrome

Nicholas G Kounis, George D Soufras, GrigoriosTsigkas, George Hahalis

Oncoimmunology. 2014; 3: e27987

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4203633/

■ Fármacos que podem provocar Síndrome de Kounis.

Rodrigues, Maria Catarina Luís, Coelho, Daniela and Granja, Cristina

Rev. Bras. Anestesiol., Out 2013, vol.63, no.5, p.426-428

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942013000500011&lng=en&nrm=iso

■ Anaphylactic shock: Kounis hypersensitivity-associated syndrome seems to be the primary cause

Nicholas G Kounis, George D Soufras, George Hahalis

N Am J Med Sci. 2013 Nov; 5(11): 631–636

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877435/

■ Kounis syndrome: a monster for the atopic patient

Nicholas G Kounis

CardiovascDiagnTher. 2013 Mar; 3(1): 1–4.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3839220/

■ Hymenoptera stings, anaphylactic shock and the Kounis syndrome

Nicholas G Kounis

N Am J Med Sci. 2013 Feb; 5(2): 159–160.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3624722/

■ Intraoperative myocardial infarction: Kounis syndrome provoked by latex allergy

Veronica Marcoux, Shravan Nosib, Henry Bi, Brian Brownbridge

BMJ Case Rep. 2013; 2013: bcr201200758

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604380/

■ Síndrome de Kounis: una posibilidad a tenerencuenta como causa de muerte súbita cardíaca

Molina, P. et al.

Cuad. med. forense, Mar 2012, vol.18, no.1, p.35-38

http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1135-76062012000100007&lng=es&nrm=iso

■ Mesalamine hypersensitivy and Kounis syndrome in a pediatric ulcerative colitis patient

George N Kounis, Sophia A Kouni, George Hahalis, Nicholas G Kounis

World J Gastroenterol. 2008 Dec 14; 14(46): 7141–7142

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776848/

by Dr Paulo Fernando Leite

■ Cardiologia/Prevenção Cardiovascular

■ Estratificação de Risco Cardiovascular

Av Contorno 8351 – Conj 01

Belo Horizonte/MG/Brasil

Tel: 31 32919216 2917003 3357229

(- consulta particular –)

CRMMG: 7026

Email: pfleite1873@gmail.com

Síndrome de Lance-Adams Online (Lance-Adams Syndrome)

Por Paulo Leite 01/10/2018

¨A síndrome de Lance-Adams (SLA) é caracterizada por mioclonias pós-hipóxicas crônicas, podendo surgir dias, semanas ou meses após grave lesão isquêmica ao sistema nervoso central. Sua incidência é muito baixa. Os pacientes que sobrevivem aos longos períodos de parada cardiorrespiratórias (PCR) geralmente cursam com graves complicações neurológicas, tais como mioclonias pós-hipóxicas. Dois tipos de mioclonias são bem descritas na literatura: mioclonia pós-hipóxica aguda, também denominada de estado epilético mioclônico, ocorrendo imediatamente ou pouco tempo após as manobras efetivas de RCP; e mioclonias pós-hipóxicas crônicas, também denominada síndrome de Lance-Adams (SLA), surgindo dias, semanas ou meses após a recuperação da consciência do paciente em coma. Ambas caracterizam-se por mioclonias generalizadas, de difícil controle medicamentoso, que caracteristicamente pioram aos estímulos táteis, verbais e sensoriais. A incidência da SLA é baixa, sendo uma síndrome rara, poucos casos no mundo são descritos até o momento¨

■ Prognostication after cardiac arrest

C Sandroni, S D´Arrigo, J P Nolan

Critical Care 2018, vol 22: 150

https://ccforum.biomedcentral.com/articles/10.1186/s13054-018-2060-7

■ Post-hypoxic myoclonus: differentianting benig and malignant etiologies in diagnosis and prognosis

Brin Freund, Peter W. Kaplan

Clin Neurophysiol Pract. 2017; 2: 98–10

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123861/

■ Lance-Adams syndrome associated with cerebellar pathology

Adam Waddell, Ahmed Dirweesh, Fausto Ordonez, et al

J Community Hosp Intern Med Perspect. 2017 Jul; 7(3): 182–184

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538244/
■ Add-on perampael in Lance-Adams syndrome

B J Steinhoff, M Bacher, C Kurth et al

Epilepsy Behav Case Rep. 2016; 6: 28–2

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939387/
■ Clinically distinct electroencephalographic phenotypes of early myoclonus after cardiac arrest

Jonathan Elmer, Jon C. Rittenberger, John Faro, Bradley J. Molyneaux,
Alexandra Popescu, Clifton W. Callaway, Maria Baldwin

Ann Neurol. 2016 Aug; 80(2): 175–184

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982787/

■ Post-hypoxic myoclonus: current concepts, neurophysiology, and treatment

Harsh V. Gupta, John N. Caviness

Tremor Other Hyperkinet Mov (N Y) 2016; 6: 409

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5039948/
■ Lance-Adams syndrome: a special case of a mother

G B Nigam, S S Babu, C S Peter, C S Peter

Indian J Crit Care Med. 2016 Sep; 20(9): 548–55

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027750/
■ Lance-Adams syndrome: a case report

D Jasinska, J Boczon

Practical Neurology 2014

http://practicalneurology.com/2014/10/lance-adams-syndrome-a-case-report

■ Acute onset Lance-Adams syndrome following brief exposure to severe hypoxia without cardiac arrest – a case report

Ah-Reum Cho, Jae-Young Kwon, Joo-Yun Kim et al

Korean J Anesthesiol. 2013 Oct; 65(4): 341–34

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822028/
■ Late relapse myoclonus in a case of Lance-Adams syndrome

Lagrand T, Winogrodzka A.

BMJ Case Rep. 2013 Nov 29;2013. pii: bcr2013201543

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3847516/

■ Acute onset Lance-Adams syndrome following brief exposure to severe hypoxia without cardiac arrest – a case report

Ah-Reum Cho, Jae-Young Kwon, Joo-Yun Kim et al

Korean J Anesthesiol. 2013 Oct; 65(4): 341–344.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822028/

■ Síndrome de Lance-Adams depois de parade cardiorrespiratória prolongada – relato de caso

D Damiani, J A Arevalo Neto, L S I Ueda, R Schneider

Rev Bras Clin Med São Paulo 2012, vol 10 (2): 152-154

http://files.bvs.br/upload/S/1679-1010/2012/v10n2/a2780.pdf

■ Lance-Adams syndrome

Shin JH, Park JM, Kim AR, Shin HS, Lee ES, Oh MK, Yoon CH.

Ann Rehabil Med. 2012 Aug;36(4):561-4

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3438425/
■ Efectividade del levetiracetam en tratamiento de dos casos de estatus mioclónico por encefalopatia hipóxia

Gea-García, J.H. de et al

Med. Intensiva, Set 2011, vol.35, no.6, p.393-39

http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0210-56912011000600011&lng=es&nrm=iso

■ Myoclonus after cardiac arrest: pitfalls in diagnosis and prognosis

W A English, N J Giffin, J P Nolan

Anaesthesia 2009, vol 64 (8): 908-911

https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2044.2009.05939.x

■ Lance-Adams Syndrome

Ha Lim Lee, J K Lee

Ann Rehabil Med 2011, vol 35 (6): 939-943

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309367/

■ Lance-Adams syndrome: difficulties surrounding diagnosis, prognostication, and treatment after cardiac arrest