Síndrome de Kounis Online (Kounis´s syndrome)

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