Kounis syndrome Facts
definition
Kounis syndrome is the concurrence of acute coronary syndromes with mast cell activation induced by allergic or hypersensitivity and anaphylactic of anaphylactoid reactions.

Also called "allergic angina and allergic myocardial infarction"

This syndrome is caused by inflammatory mediators released mainly from activated mast cells and the interrelated via bidirectional stimuli macrophages and T-lymphocytes. Since activated mast cells abound at the areas of plaque erosion or rupture in patients suffering from acute myocardial infarction a common pathway between allergic and non allergic coronary events seems to exist.

type I variant of Kounis syndrome. This variant includes patients, of any age, with normal coronary arteries, without predisposing factors for coronary artery disease, in whom the acute release of inflammatory mediators from mast cells can induce either sudden coronary artery narrowing, without increase of cardiac enzymes and troponins, or coronary artery spasm that progresses to acute myocardial infarction, with elevated cardiac enzymes and troponins..

This has been provoked by both drug and food allergies and insect stings.

The clinical symptoms of allergic angina include chest discomfort, dyspnoea, faintness, nausea, pruritus and urticaria. They are accompanied by signs such as hypotension, diaphoresis, pallor and bradycardia. There are also electrocardiographic findings indicating myocardial ischaemia, arrhythmias and conduction defects..

NO previous cardiac history has to be present for this to happen.

IT IS TREATED BY stopping the anaphlactic episode quickly and calming the mast cells as soon as possible--antihistamines and cortisones IV, nitrates and calcium channel blockers.

It is most common in mast cell disease patients who also complain of PVCs,  tachycardia and angina.

It CAN be prevented and stopped.

If Kounis syndrome isnt stopped, it may go into takasubo syndrome, attacking the left ventricle of the heart. The left ventricle balloons out and echocardiograms will sho anterior wall infarct. This too CAN be stopped by quick administration of H1 and H2 antihistamines IV and steriods IV.

A direct result of coronary vasospasm, which in turn gives rise to presyncope and syncope attacks.

Susceptible individuals expressing an amplified mast cell degranulation effect may be more vulnerable to coronary artery spasm.

NO aspirin or beta-blockers--they can bring on angina and kounis syndrome during allergic reaction episodes already in progress.

The effects of histamine on cardiac function are mediated via H1- and H2- receptors situated on the four cardiac chambers and coronary arteries. Coronary arteries of cardiac patients are hyperactive and contain stores of histamine which can initiate coronary artery spasm.

The clinical symptoms of allergic angina include chest discomfort, dyspnea, faintness, nausea, pruritus and urticaria. They are accompanied by signs such as hypotension, diaphoresis, pallor and bradycardia. There are also electrocardiographic findings indicating myocardial ischaemia, arrhythmias and conduction defects. Thus, in patients undergoing acute allergic reaction, the development of chest pain could be explained by the mechanism of coronary arterial spasm provoked by the release of histamine, which constitutes the
syndrome of allergic angina.


Treatment

   * Epinephrine is life saving in anaphylaxis but in Kounis syndrome can aggravate ischemia and induce coronary vasospasm. Sulfite free epinephrine is recommended I.M. 0.2-0.5 mg (1:1000) of aqueous solution is preferable.
   * In patients on b-blockers epinephrine may be ineffective. It may also promote more vasospasm due to unopposed alpha adrenergic effect. Glucagon may be considered.
   * Avoid opiates such as morphine, codeine and meperidine since they can induce massive mast cell degranulation and aggravate allergic reaction.
   * Fentanyl and its derivatives show a slight mast cell activation and should be the drugs of choice when narcotic analgesia is necessary

What does this mean to Masto patients??

Anytime masto patients experience chest pain, view it as a possible mast cell reaction on the vessels of the heart and take 2 antihistamines an H1 and H2 blocker immediately, NO aspirin.
Immediate H1 and H2 blockers

When we go into shock, it is important to have this info in our ER notebooks so medical staff can react quickly and appropriately.

Thanks, I hope the results show the episode was a lesser one. Did they know to use H1 H2 blockers and cortisone IV?? Smart man figuring that one out!
hugs
Ramona

Hi Ramona!  Thanks so much for posting this.  Where did you find the original copy so I can give this to my cardiologist?

Hope you're doing well....
Jared  

Can there be high blood pressures and tachycardia with this syndrome?  I went to ER with what I thought was an allergy attack and had horrible time getting my heart rate and blood pressure to come down.  I took allot of antihistimines before going and then they gave me nitro glycerin and an IV and it started to come down.  Wondering if this attack was this syndrome?