Kounis综合征Ⅰ型1例

<正>患者,男,36岁,主因突发颜面潮红、畏寒,伴有大汗2h于2014年2月7日入院。患者病程中伴头晕,不能站立,感心悸,无胸闷、胸痛,发病前进食啤酒、龙虾,自诉有龙虾过敏史,既往体健。查体:BP 154/78 mmHg(1 mmHg=0.133 kPa),R30次/min,神志清晰,轻度憋喘貌,可平卧,口唇紫绀,颈静脉无怒张,双肺呼吸音粗,双肺未闻及啰音,HR 90次/min,律整,心音低钝,未闻及病理性     

青霉素过敏引起的Kounis综合征1例

目前,抗生素应用越来越广泛,引起的不良反应亦表现各异,我科曾收治1例药物过敏的患者,主要表现为冠状动脉痉挛,特报道如下。     

Kounis综合征二例误诊临床分析

目的探讨Kounis综合征的临床特点及误诊原因,提高诊治水平。方法回顾性分析误诊为其他疾病的Kounis综合征2例的临床资料。结果 1例因胸闷、胸痛20 min急诊入院,误诊为急性下壁心肌梗死、药物过敏,予抗心肌缺血和抗过敏治疗后病情稍好转; 1例因间断胸闷、胸痛、气短3 d就诊,误诊为冠心病、不稳定型心绞痛,予抗心肌缺血治疗后病情无明显改善,后加用抗过敏治疗后病情好转。综合病史、医技检查结果,确诊为Kounis综合征Ⅰ型与Kounis综合征Ⅱ型。随访3个月,患者病情均未复发。结论 Kounis综合征缺乏特异性临床表现,加强认识、提高诊治水平是医生尽早确诊、改善预后的关键。     

三支冠脉血管痉挛的Kounis综合征1例北大核心CSCD

Kounis综合征又称过敏性心绞痛综合征,最早在1991年由希腊医师Kounis和Zavras[1]报道,由于Kounis对过敏所致的心绞痛和心肌梗死进行了较多的深入研究和报道,故许多学者又称该综合征为Kounis综合征[2],其主要临床表现为急性冠脉综合征及急性过敏反应为主。诊断要点如下,①过敏介质的接触史;②过敏反应的相关临床表现,伴随心肌缺血的临床表现。     

对比剂过敏引发的Ⅰ型Kounis综合征1例报告

一位39岁女性在接受冠脉CTA检查时注射对比剂后数分钟出现过敏性休克、心电图ST段抬高及心跳骤停。给予心肺复苏、肾上腺素、皮质类固醇等治疗后患者恢复意识、症状缓解、生命体征平稳。复查心电图示原抬高的ST段回落，冠脉CTA未见狭窄病变。考虑该患者为对比剂过敏诱导的冠状动脉痉挛引起的I型Kounis综合征（与过敏相关的ST段抬高性急性冠脉综合征）。     

Brugada综合征的研究现状

1991年西班牙 Pedro Brugada及 Josep Brugada两兄弟首先报道本病。特点是无器质性心脏病诊断依据 ,心电图表现为 V1 ～V3 持续 ST段升高、右束支传导阻滞、正常 QT间期 ,而反复发生多形性室性心动过速、心室颤动及心脏猝死。 1996年日本学者Miyazaki等首次将此病独特临床电生理特征称之为 Brugada综合征。由于该病与猝死密切相关 ,已被作为一个独立的、可预测恶性室性心律失常和猝死的因子而倍受关注。现就该病发生机制、临床表现及治疗等研究现状简要综述如下。1　临床表现Brugada综合征多发生于健康男性 ,好发年龄为 32～ 40岁。男…     

Evans综合征的研究现状

Evans综合征(Evans syndrome,ES)又称Fisher-Evans综合征,为一种自身免疫性疾病,系血细胞特异性自身抗体引起红细胞和血小板破坏增加,而导致相继或同时发生自身免疫性溶血性贫血(AIHA)和免疫性血小板减少症(immune thrombocytopenia,ITP)。     

代谢综合征研究现状

代谢综合征（metabolic syndrome，MS）是一种以代谢紊乱为特征的征候群，并已作为2型糖尿病及心血管疾病的独立预测因素正越来越受到广泛关注。MS主要包括中心性肥胖、糖耐量异常、血脂代谢紊乱等危险因素，MS患者糖尿病、心血管疾病的发病率约是正常人群的5倍，严重危害人类的身心健康。美国2000年人口普查资料显示MS已累及了24％的成人（20～70岁），我国的流行病学资料显示，一般人群MS的患病率为13．3％，并且随着年龄增加患病率不断升高；上海的调查显示45岁以上人群MS患病率达到16．9％，65-69岁则高达38．3％。笔者就有关代谢综合征的组成、发病机制、有关其核心环节的争论以及治疗措施作一综述。     

肝肺综合征的研究现状

肝肺综合征（hepatopulmonmy syndrome,HPS）是在慢性肝病和（或）门静脉高压基础上出现肺血管扩张、动脉血氧合功能异常,临床上以肝功能不全、肺血管扩张、进行性呼吸困难、低氧血症为主要表现,并具有慢性肝病、肺泡动脉血氧分压差[P（A-a）2]增大或动脉血氧分压（PaO2）降低和肺内血管扩张的临床三联症[1].HPS起病隐匿,临床症状不典型,且发病机制复杂,检查诊断困难,无有效治疗手段,导致其临床预后不良,本文就HPS的病因、发病机制、临床表现及诊断与治疗的研究进展作一综述,供临床诊疗参考.     

多囊卵巢综合征的研究现状

多囊卵巢综合征(polycystic ovarian syndrome,PCOS)是一种生殖功能障碍与糖代谢异常并存的内分泌紊乱综合征,临床表现为持续性无排卵、卵巢多囊样改变(polycystic ovary,PCO)、雄激素过多和胰岛素抵抗(insulin resistance,IR)等,是生育期妇女月经紊乱、导致不孕的最常见的原因,其病因至今尚未阐明。近年来,国内外对该病的研究均有一定进展,现将     

Vancomycin-induced Kounis Syndrome

Kounis Syndrome is a rare allergic reaction that results in coronary vasospasm and may occur in patients with and without coronary artery disease. A 57-year-old man receiving pre-operative vancomycin for osteomyelitis and gangrene of the foot experienced an episode of anginal symptoms associated with transient ischemic 12-lead electrocardiogram (ECG) changes. The patient's symptoms and ECG changes abated with discontinuation of vancomycin and subsequent coronary angiography revealed no evidence of coronary artery disease. Treatment of Kounis Syndrome begins with cessation of the causative agent. Consensus guidelines for the management of Kounis Syndrome have not been established but treatment should both dilate the coronary vessels and suppress the allergic response. Coronary vasospasm after administration of antibiotics, including vancomycin, is a rare but serious reaction. It is important that Emergency Physicians recognize Kounis Syndrome as an uncommon yet dramatic and consequential reaction to such a commonly-administered antibiotic.     

Kounis syndrome

The association between acute coronary events and acute allergic reactions has been recognized for several years. The first reported case occurred in 1950, during an allergic reaction to penicillin. In 1991, Kounis and Zavras described the syndrome of allergic angina and allergic myocardial infarction, currently known as Kounis syndrome. Two subtypes have been described: type I, which occurs in patients without predisposing factors for coronary artery disease and is caused by coronary artery spasm, and type II, which occurs in patients with angiographic evidence of coronary disease when the allergic events induce plaque erosion or rupture. This syndrome has been reported in association with a variety of medical conditions, environmental exposures, and medication exposures. Entities such as Takotsubo cardiomyopathy, drug-eluted stent thrombosis, and coronary allograft vasculopathy appear to be associated with this syndrome. In this review, we discuss the pathobiology, clinical features, associated entities, and management of Kounis syndrome.     

Acute ST Elevation Myocardial Infarction Due to Allergic Reaction,Kounis Syndrome

Kounis syndrome is defined by the occurrence of an acute coronary syndrome (ACS) in the setting of an allergic, hypersensitivity or anaphylactic condition. Degranulation of mast cells and platelet activation leading to the release of multiple inflammatory mediators are thought to make the arterial circulation susceptible to acute cardiac events. It is an often underdiagnosed entity in the emergency setting, due to lack of awareness among emergency providers. Identifying Kounis syndrome is critical, since managing ACS differs from that of a classical acute myocardial infarction. We present the case of a 72-year old male patient with a history of stable coronary disease who presented to the emergency department with a diffuse pruritic rash and chest pain. Electrocardiogram showed ST elevation myocardial infarction. Urgent coronary angiography revealed total occlusion of the mid left anterior descending coronary artery which was treated with a drug eluting stent with an excellent outcome. The pruritic rash responded to treatment with intravenous corticosteroids and antihistamines; No allergens were identified. The patient’s symptoms resolved and he had an uneventful hospitalization.The diagnosis of Kounis syndrome can complicate the management of acute allergic reactions. Special precautions should be taken by emergency physicians with regards to the administration of beta blockers, morphine and vasodilators, which may be detrimental in this setting.     

Kounis syndrome and ziprasidone

Kounis syndrome (KS), described by Kounis and Zavras in 1991, is the manifestation of an allergic reaction preceding and leading to an acute coronary syndrome (ACS). There are three variants of Kounis Syndrome. Here we describe a novel case report of a type 1 variant secondary to Ziprasidone.     

Kounis syndrome secondary to allergic reaction following shellfish ingestion

Two cases of allergic angina and allergic myocardial infarction (Kounis syndrome) secondary to shellfish ingestion are described. The patients had pre-existing quiescent coronary artery disease (type II variant of the syndrome) and the allergic reaction following eating shellfish seemed to have triggered the development of an acute myocardial infarction. The clinical implications are also discussed.