摘要
Kounis syndrome is defined as a group of acute coronary syndromes that manifests as unstable vasospasticor nonvasospastc angina, and even as acute myocarda! infarction triggered by the release of inflammatory mediators following an allergic insult.1 Kounis syndrome is a rare and complex syndrome. Instant treatment decisions need to be made once it happens. Here, we defined a case of severe Kounis syndrome, culminating in acute coronary syndrome, as a result of an acute allergic reaction, which was likely related to iodinated contrast media or dextran-40 use. A 71-year-old male patient, with a history of hypertension, no history of coronary heart disease and diabetes, was admitted to our hospital because of intermittent claudication for one year. On admission, his temperature was 36.4℃, pulse was 80 beats/min, respiratory rate was 18 beats/rain and blood pressure was 105/80 mmHg （1 mmHg=0.133 kPa）. Physical examination did not show any sign of heart disease, but the lower extremity arterial pulsation was weak. His artery angiography of abdominal aorta and lower limbs showed that the left iliac artery was completely obstructed. A total of 400 U iodinated contrast media was used during the operation. The patient was back to ward safely. Ten minutes after taking the dextran-40 as a postoperative treatment, he began to present sudden hyperspasmia, transient unconsciousness, skin flushes, excessive sweating and sinus tachycardia （approximately 140 beats/min）. At the same time, his skin temperature decreased and his blood pressure collapsed quickly. He accepted oxygen therapy, fluid replacement, dexamethasone and dopamine immediately. After that the ECG revealed ST elevation of 0.3-0.7 mV in leads II, III, avF, V3.6, and frequent premature ventricular （Figure 1A）. Following the therapy of promethazine, glycerin trinitrate and lidocaine, the shock symptoms was gradually relieved： consciousness was recovered, ST segment gradually went back to normal in half an hour （Figure 1 B） and blood pressure increased to 50/40 mmHg. However, the skin appeared in pattern and urticaria. The patient was transferred to CCU ward for observation, with dopamine used constantly for a few hours. The patient＇s general state was stable after a few hours. His skin rash vanished gradually and his blood pressure was back to 90/60 mmHg. The ECG had no specific changes in the next day. The infarction graphics had only a one- time change, so we did not take further examinations forcardiac markers because it disappeared quickly. The patient accepted a short-term anti-platelet aggregation therapy after he was stable. He was discharged from the hospital after he successfully accepted femoral artery endarterectomy in half month. The discharge diagnosis was left lower extremity arteriosclerosis obliterans. The patient was followed up for several years after discharge. He did not complain any symptoms of angina pectoris or heart failure. The most common symptoms of Kounis syndrome, include fainting, dyspnea, palpitation, serious weakness, nausea, vomiting, urticaria, itching, profuse sweating, paleness, hypotonia and sometimes arrhythmia. The patient described here developed signs of anaphylaxis in an hour after using iodinated contrast media and dextran-40. The diagnosis of this case mainly relies on the patient＇s typical symptoms and ECG （ischemic ST-T changes）. The symptoms of hypotension caused by the release of vascular active substances expand capillaries widely in allergic reactions. During the reaction, peripheral resistance decreases as vascular permeability and capillary capacity increase, so blood pressure dropped rapidly. Furthermore, hypotension can aggravate the myocardial hypoperfusion. After taking the H1 blocker, corticosteroids, rehydration, and so on, the
Kounis syndrome is defined as a group of acute coronary syndromes that manifests as unstable vasospasticor nonvasospastc angina, and even as acute myocarda! infarction triggered by the release of inflammatory mediators following an allergic insult.1 Kounis syndrome is a rare and complex syndrome. Instant treatment decisions need to be made once it happens. Here, we defined a case of severe Kounis syndrome, culminating in acute coronary syndrome, as a result of an acute allergic reaction, which was likely related to iodinated contrast media or dextran-40 use. A 71-year-old male patient, with a history of hypertension, no history of coronary heart disease and diabetes, was admitted to our hospital because of intermittent claudication for one year. On admission, his temperature was 36.4℃, pulse was 80 beats/min, respiratory rate was 18 beats/rain and blood pressure was 105/80 mmHg （1 mmHg=0.133 kPa）. Physical examination did not show any sign of heart disease, but the lower extremity arterial pulsation was weak. His artery angiography of abdominal aorta and lower limbs showed that the left iliac artery was completely obstructed. A total of 400 U iodinated contrast media was used during the operation. The patient was back to ward safely. Ten minutes after taking the dextran-40 as a postoperative treatment, he began to present sudden hyperspasmia, transient unconsciousness, skin flushes, excessive sweating and sinus tachycardia （approximately 140 beats/min）. At the same time, his skin temperature decreased and his blood pressure collapsed quickly. He accepted oxygen therapy, fluid replacement, dexamethasone and dopamine immediately. After that the ECG revealed ST elevation of 0.3-0.7 mV in leads II, III, avF, V3.6, and frequent premature ventricular （Figure 1A）. Following the therapy of promethazine, glycerin trinitrate and lidocaine, the shock symptoms was gradually relieved： consciousness was recovered, ST segment gradually went back to normal in half an hour （Figure 1 B） and blood pressure increased to 50/40 mmHg. However, the skin appeared in pattern and urticaria. The patient was transferred to CCU ward for observation, with dopamine used constantly for a few hours. The patient＇s general state was stable after a few hours. His skin rash vanished gradually and his blood pressure was back to 90/60 mmHg. The ECG had no specific changes in the next day. The infarction graphics had only a one- time change, so we did not take further examinations forcardiac markers because it disappeared quickly. The patient accepted a short-term anti-platelet aggregation therapy after he was stable. He was discharged from the hospital after he successfully accepted femoral artery endarterectomy in half month. The discharge diagnosis was left lower extremity arteriosclerosis obliterans. The patient was followed up for several years after discharge. He did not complain any symptoms of angina pectoris or heart failure. The most common symptoms of Kounis syndrome, include fainting, dyspnea, palpitation, serious weakness, nausea, vomiting, urticaria, itching, profuse sweating, paleness, hypotonia and sometimes arrhythmia. The patient described here developed signs of anaphylaxis in an hour after using iodinated contrast media and dextran-40. The diagnosis of this case mainly relies on the patient＇s typical symptoms and ECG （ischemic ST-T changes）. The symptoms of hypotension caused by the release of vascular active substances expand capillaries widely in allergic reactions. During the reaction, peripheral resistance decreases as vascular permeability and capillary capacity increase, so blood pressure dropped rapidly. Furthermore, hypotension can aggravate the myocardial hypoperfusion. After taking the H1 blocker, corticosteroids, rehydration, and so on, the
