Kounis syndrome: Difference between revisions
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==Background== | ==Background== | ||
Acute coronary syndromes associated with mast cell activation ([[anaphylaxis]] or [[anaphylactoid reaction]]) | Acute coronary syndromes associated with mast cell activation ([[anaphylaxis]] or [[anaphylactoid reaction]]). Also known as Coronary hypersensitivity disorder.<ref> Kounis N. Coronary hypersensitivity disorder: The Kounis syndrome. Clin Ther. 2013 May;35(5):563-71</ref> | ||
==Clinical Features== | ==Clinical Features== | ||
*Stent thrombosis is the main manifestation of Kounis syndrome due to the mast cell infiltration of areas protected by drug-eluting stents<ref>Kounis NG. Kounis syndrome should be considered the culprit cause of the most feared stent thrombosis. J Am Coll Cardiol. 2011;58:885.</ref> | |||
*ECG changes will correlate with the [[ACS anatomical correlation|anatomical region of ischemia]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Chest Pain DDX}} | |||
{{Elevated troponin DDX}} | |||
==Evaluation== | ==Evaluation== | ||
''Intensity of treatment should be based on ACS likelihood'' | |||
*[[ST-Elevation Myocardial Infarction (STEMI)]] | |||
*[[Non ST-Elevation Myocardial Infarction (NSTEMI)]] | |||
*[[Unstable Angina]] | |||
===Workup=== | ===Workup=== | ||
*Should proceed according to standard [[Acute_coronary_syndrome_(main)#Evaluation|ACS evaluations]] | |||
===Diagnosis=== | ===Diagnosis=== | ||
*Standard ACS workup | |||
*Serum IgE levels may be elevated | |||
==Management== | ==Management== | ||
*Primary treatment should focus on cessation of the [[Anaphylaxis#Management|anaphylactic or allergic event]] | |||
==Disposition== | ==Disposition== | ||
*Admission for monitoring with cardiology consult | |||
==See Also== | ==See Also== | ||
*[[ACS]] | |||
*[[Anaphylaxis]] | |||
==External Links== | ==External Links== | ||
Latest revision as of 05:41, 20 August 2022
Background
Acute coronary syndromes associated with mast cell activation (anaphylaxis or anaphylactoid reaction). Also known as Coronary hypersensitivity disorder.[1]
Clinical Features
- Stent thrombosis is the main manifestation of Kounis syndrome due to the mast cell infiltration of areas protected by drug-eluting stents[2]
- ECG changes will correlate with the anatomical region of ischemia
Differential Diagnosis
Chest pain
Critical
- Acute coronary syndromes (ACS)
- Aortic dissection
- Cardiac tamponade
- Coronary artery dissection
- Esophageal perforation (Boerhhaave's syndrome)
- Pulmonary embolism
- Tension pneumothorax
Emergent
- Cholecystitis
- Cocaine-associated chest pain
- Mediastinitis
- Myocardial rupture
- Myocarditis
- Pancreatitis
- Pericarditis
- Pneumothorax
Nonemergent
- Aortic stenosis
- Arthritis
- Asthma exacerbation
- Biliary colic
- Costochondritis
- Esophageal spasm
- Gastroesophageal reflux disease
- Herpes zoster / Postherpetic Neuralgia
- Hypertrophic cardiomyopathy
- Hyperventilation
- Mitral valve prolapse
- Panic attack
- Peptic ulcer disease
- Pleuritis
- Pneumomediastinum
- Pneumonia
- Rib fracture
- Stable angina
- Thoracic outlet syndrome
- Valvular heart disease
- Muscle sprain
- Psychologic / Somatic Chest Pain
- Spinal Root Compression
- Tumor
Elevated Troponin
True Positive
False (Non-CAD) Positives
- Pericarditis
- Myocarditis
- PE
- CHF
- Sepsis
- Dissection
- Arrhythmias
- CVA
- SAH
- Burns
- Renal failure
- Assume true positive until proven otherwise
- ESRD
- 86% elevated predialysis in troponin-T
- 6% elevated predialysis in troponin-I
- no difference in post-MI troponin-I clearance rate in ESRD vs. normal GFR
- Cardioversion
- Cardiotoxic medications
- Amyloidosis
- Rheumatoid Factor
- Heterophilic antibodies
- Apical ballooning syndrome
- Cardiac procedures (surgery, ablation, pacing, stenting)
- Extreme exertion
Evaluation
Intensity of treatment should be based on ACS likelihood
- ST-Elevation Myocardial Infarction (STEMI)
- Non ST-Elevation Myocardial Infarction (NSTEMI)
- Unstable Angina
Workup
- Should proceed according to standard ACS evaluations
Diagnosis
- Standard ACS workup
- Serum IgE levels may be elevated
Management
- Primary treatment should focus on cessation of the anaphylactic or allergic event
Disposition
- Admission for monitoring with cardiology consult