Acute coronary syndrome caused by allergic reaction (Kounis syndrome): a literature review

Gabrielė Žūkaitė1, Rasa Šimoniūtytė2, Agnė Baliūnaitė1

1Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania

2Vilnius City Clinical Hospital, Department of Internal Medicine, Vilnius, Lithuania


Background. Kounis syndrome is a cardiac pathology manifested by angina pectoris or myocardial infarction caused by an acute allergic reaction. There are three types of this syndrome: type 1 is caused by coronary artery spasm and patients are without risk factors, type 2 is allergic myocardial infarction and type 3 is caused by stent thrombosis or restenosis. The main clinical symptoms are chest pain, rash, hypotension and shortness of breath.

Aim: to select and analyze the latest diagnostic and treatment recommendations for Kounis syndrome based on the experience of foreign researchers and to discuss the etiology, pathogenesis and clinical symptoms.

Material and methods. A systematic review of the medical literature was performed using databases of PubMed, Elsevier, Google Scholar, and guidelines of European Society of Cardiology. The search was performed using the following keywords and their combinations in English: Kounis syndrome, vasospastic angina, MINOCA, syndrome X, acute coronary syndrome, allergy induced angina pectoris, allergy induced myocardial infarction.

Results: The main diagnostic principles are based on clinical symptoms, laboratory blood tests (troponin I), ECG, coronary artery angiography and echocardiography. The treatment of this syndrome depends on the type, but the most important thing is to stop the progression of the allergic reaction and myocardial ischaemia.

Conclusion. The prognosis of Kounis syndrome is favorable and most patients make a full recovery. Serious complications are rare. Kounis syndrome still remains a rarely diagnosed disease, because there is still a lack of guidelines on how to properly treat and diagnose this syndrome.

Keywords: Kounis syndrome, acute coronary syndrome, allergy, vasospastic angina.

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