Allergen-Related Coronary Vasospasm “Kounis Syndrome” Requiring Administration of Epinephrine and a Coronary Vasodilator

• Published in: Journal of cardiothoracic and vascular anesthesia 2021-09, Vol.35 (9), p.2768-2771
• Main Authors: Shintani, Ryosuke, Sekino, Motohiro, Egashira, Takashi, Yano, Rintaro, Inoue, Haruka, Matsumoto, Sojiro, Higashijima, Ushio, Matsumoto, Shuhei, Yonekura, Tsuyoshi, Hara, Tetsuya
• Format: Article
• Language: English
• Subjects: Allergens - adverse effects; anaphylaxis; Anaphylaxis - chemically induced; Anaphylaxis - diagnosis; Anaphylaxis - drug therapy; coronary vasospasm; Coronary Vasospasm - chemically induced; Coronary Vasospasm - diagnosis; Coronary Vasospasm - drug therapy; Electrocardiography; epinephrine; Epinephrine - therapeutic use; Humans; Kounis syndrome; Kounis Syndrome - diagnosis; Kounis Syndrome - drug therapy; nicorandil; therapeutic management; Vasodilator Agents - therapeutic use
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2020.08.009

Kounis syndrome is an anaphylactic reaction leading to acute coronary syndrome. The acute treatment of anaphylaxis is epinephrine; however, epinephrine may cause coronary vasoconstriction, reduce coronary blood flow, increase myocardial oxygen demand, and worsen myocardial ischemia. On the other hand, coronary vasodilation, a treatment for acute coronary syndrome, can aggravate hypotension in patients with anaphylaxis. Herein, the authors report a case of type II Kounis syndrome, with vasospasm in a patient with coronary disease, requiring the administration of epinephrine and a coronary vasodilator for resuscitation. The authors administered intravenous epinephrine continuously from lower dosages and performed delicate titration. The coronary vasodilator nicorandil, which has little effect on hemodynamics, also was administered. These treatments improved hemodynamics without complications. Circulatory management that considers both anaphylaxis and coronary lesions is crucial to improve prognosis in this syndrome.