Abstract
Background: Kounis syndrome is defined as a combination of acute coronary syndrome and allergic reactions.
Objective: In this review, we aim to describe the etiological, clinical, and diagnostic characteristics of Kounis syndrome.
Methods: A literature search using PubMed was conducted for the past 32 years using keywords, resulting in the selection of 761 scientific papers. From these, 217 articles describing 235 clinical cases were selected. Patients under 18 years of age or without a confirmed diagnosis were excluded.
Results: Among the 235 patients, type I Kounis syndrome was observed in 49.7%, type II in 27.2%, type III in 5.9%, and a combination of types I and II in 1.0%; in 16.2%, it was not possible to classify the type of Kounis syndrome. The median age was 57 years, and 68.5% of the patients were male. The most common causes were antibiotics (32.3%) and non-steroidal anti-inflammatory drugs (24.3%). The clinical features included chest pain (59.1%), hypotension (74.2%), itching (30.6%), and dyspnea (30.6%). Electrocardiographic monitoring revealed ST-segment elevation in 42.9% and was normal in only 5.5% of patients. Coronary angiography was performed in 80.4% of the patients, revealing unchanged coronary arteries in 50.3% of cases.
Сonclusion: Allergic myocardial infarction is a serious complication of drug therapy.
[http://dx.doi.org/10.1016/j.ejim.2015.12.004] [PMID: 26795552]
[http://dx.doi.org/10.6515/ACS.202307_39(4).20230416B] [PMID: 37456935]
[http://dx.doi.org/10.1155/2022/6087176] [PMID: 35783461]
[PMID: 20461972]
[http://dx.doi.org/10.1016/j.jccase.2022.10.004] [PMID: 36788958]
[http://dx.doi.org/10.26355/eurrev_202011_23830] [PMID: 33275246]
[http://dx.doi.org/10.1016/j.ijcard.2007.12.099] [PMID: 18378022]
[http://dx.doi.org/10.1016/j.ijcard.2011.07.049] [PMID: 21839530]
[http://dx.doi.org/10.2459/JCM.0b013e32833dadd5] [PMID: 20671566]
[http://dx.doi.org/10.1016/j.ijcard.2011.10.026] [PMID: 22104989]
[http://dx.doi.org/10.1016/j.ijcard.2013.07.209] [PMID: 23954011]
[http://dx.doi.org/10.5144/0256-4947.2014.250] [PMID: 25266187]
[http://dx.doi.org/10.1016/j.ijcard.2016.01.103] [PMID: 26800128]
[http://dx.doi.org/10.18176/jiaci.0247] [PMID: 30073956]
[http://dx.doi.org/10.1002/clc.4960200713] [PMID: 9220183]
[http://dx.doi.org/10.1016/S0025-7753(03)75196-3] [PMID: 12975044]
[http://dx.doi.org/10.5152/akd.2011.017] [PMID: 21220239]
[http://dx.doi.org/10.1016/j.bjan.2013.04.006] [PMID: 24263049]
[http://dx.doi.org/10.4103/0019-5049.115614] [PMID: 23983288]
[PMID: 29338163]
[http://dx.doi.org/10.33716/bmedj.599198]
[http://dx.doi.org/10.1177/1024907919845526]
[http://dx.doi.org/10.18176/jiaci.0876] [PMID: 36515651]
[http://dx.doi.org/10.1002/ccr3.7121] [PMID: 36950673]
[http://dx.doi.org/10.18176/jiaci.0921] [PMID: 37294099]
[http://dx.doi.org/10.5543/tkda.2017.58827] [PMID: 29664430]
[http://dx.doi.org/10.1016/j.ijcard.2011.11.059] [PMID: 22192298]
[http://dx.doi.org/10.1097/MJT.0000000000001027] [PMID: 31567140]
[http://dx.doi.org/10.3390/medicina58070855] [PMID: 35888574]
[PMID: 35275472]
[http://dx.doi.org/10.7759/cureus.10498] [PMID: 33094042]
[http://dx.doi.org/10.1111/1742-6723.13377] [PMID: 31419012]
[http://dx.doi.org/10.1016/j.ajem.2019.06.004] [PMID: 31182359]
[http://dx.doi.org/10.1007/s00508-017-1183-1] [PMID: 28255796]
[http://dx.doi.org/10.12890/2021_002249] [PMID: 33768068]
[http://dx.doi.org/10.1177/014107680509800108] [PMID: 15632231]
[http://dx.doi.org/10.1016/j.ijcard.2006.11.165] [PMID: 17360053]
[http://dx.doi.org/10.1016/j.ijcard.2007.06.029] [PMID: 17707099]
[http://dx.doi.org/10.1111/j.1532-5415.2008.01912.x] [PMID: 19166448]
[http://dx.doi.org/10.1016/j.ijcard.2009.01.031] [PMID: 19203807]
[http://dx.doi.org/10.1016/j.ijcard.2009.04.049] [PMID: 19482364]
[http://dx.doi.org/10.1016/j.ijcard.2010.05.038] [PMID: 20541820]
[http://dx.doi.org/10.1016/j.ijcard.2010.04.086] [PMID: 20605239]
[http://dx.doi.org/10.1016/j.ijcard.2010.04.028] [PMID: 20537420]
[http://dx.doi.org/10.1016/j.ijcard.2010.02.066] [PMID: 20223532]
[http://dx.doi.org/10.1016/j.ijcard.2009.04.026] [PMID: 19428133]
[http://dx.doi.org/10.1016/j.ijcard.2009.03.104] [PMID: 19395094]
[http://dx.doi.org/10.1345/aph.1K288] [PMID: 18430794]
[http://dx.doi.org/10.1016/j.hrtlng.2009.06.012] [PMID: 20207277]
[http://dx.doi.org/10.1016/j.jccase.2011.04.004] [PMID: 30532871]
[http://dx.doi.org/10.1016/j.ijcard.2011.09.075] [PMID: 21996416]
[http://dx.doi.org/10.1080/AC.66.4.2126625] [PMID: 21894822]
[http://dx.doi.org/10.1177/1078155211423118] [PMID: 22020660]
[http://dx.doi.org/10.1080/08998280.2011.11928695] [PMID: 21566756]
[http://dx.doi.org/10.1016/j.ijcard.2010.04.069] [PMID: 20471121]
[http://dx.doi.org/10.1016/j.ijcard.2009.09.534] [PMID: 19892418]
[http://dx.doi.org/10.1016/j.ijcard.2011.02.060] [PMID: 21429602]
[http://dx.doi.org/10.1016/j.ijcard.2011.02.066] [PMID: 21420182]
[http://dx.doi.org/10.1200/JCO.2011.36.4265] [PMID: 21969496]
[http://dx.doi.org/10.1177/0267659111410347] [PMID: 21628340]
[http://dx.doi.org/10.4103/0972-2327.61282] [PMID: 20436751]
[http://dx.doi.org/10.1016/j.jccase.2012.11.003] [PMID: 30533127]
[http://dx.doi.org/10.5543/tkda.2012.54077] [PMID: 23363946]
[http://dx.doi.org/10.1016/j.ijcard.2011.12.032] [PMID: 22222426]
[http://dx.doi.org/10.1016/j.ijcard.2012.03.110] [PMID: 22483259]
[http://dx.doi.org/10.5152/akd.2012.191] [PMID: 22877900]
[http://dx.doi.org/10.1016/j.rec.2012.04.011] [PMID: 22818816]
[http://dx.doi.org/10.1016/j.ajem.2011.12.016] [PMID: 22386343]
[http://dx.doi.org/10.2169/internalmedicine.51.7852] [PMID: 22892496]
[http://dx.doi.org/10.5543/tkda.2012.03592] [PMID: 23518891]
[http://dx.doi.org/10.4103/0259-1162.103388] [PMID: 25885514]
[http://dx.doi.org/10.1016/j.jccase.2013.08.003] [PMID: 30534285]
[http://dx.doi.org/10.1016/j.ijcard.2013.07.044] [PMID: 23928337]
[http://dx.doi.org/10.1016/j.ijcard.2013.03.172] [PMID: 23642606]
[http://dx.doi.org/10.1016/j.ijcard.2014.05.008] [PMID: 24857324]
[http://dx.doi.org/10.1155/2014/742905] [PMID: 25435880]
[http://dx.doi.org/10.14740/cr325w] [PMID: 28348706]
[http://dx.doi.org/10.5543/tkda.2014.92891] [PMID: 25080953]
[http://dx.doi.org/10.4103/0976-500X.171877] [PMID: 26813799]
[http://dx.doi.org/10.1136/bcr-2012-006252] [PMID: 23093500]
[http://dx.doi.org/10.1186/s13104-015-1072-5] [PMID: 25889048]
[http://dx.doi.org/10.7196/SAMJnew.8767] [PMID: 26636160]
[http://dx.doi.org/10.5543/tkda.2015.44567] [PMID: 26363750]
[http://dx.doi.org/10.1016/j.jccase.2015.05.012] [PMID: 30546573]
[http://dx.doi.org/10.1002/ccd.25960] [PMID: 26257014]
[http://dx.doi.org/10.1016/j.ijcard.2015.03.082] [PMID: 25777280]
[http://dx.doi.org/10.1053/j.jvca.2015.02.001] [PMID: 25939964]
[http://dx.doi.org/10.1007/s12928-015-0320-x] [PMID: 25652245]
[http://dx.doi.org/10.1016/j.ijcard.2016.02.079] [PMID: 26896617]
[http://dx.doi.org/10.1016/j.ajem.2016.11.061] [PMID: 27919473]
[http://dx.doi.org/10.1016/j.therap.2016.06.004] [PMID: 27692979]
[http://dx.doi.org/10.14744/AnatolJCardiol.2016.7335] [PMID: 27872436]
[http://dx.doi.org/10.14744/AnatolJCardiol.2017.7690] [PMID: 28529288]
[http://dx.doi.org/10.1177/0025817217695904] [PMID: 29210337]
[http://dx.doi.org/10.1177/2048872617701885] [PMID: 28345355]
[http://dx.doi.org/10.1186/s13256-017-1310-7] [PMID: 28532437]
[http://dx.doi.org/10.5543/tkda.2017.38845] [PMID: 28694403]
[PMID: 28457118]
[http://dx.doi.org/10.14744/AnatolJCardiol.2017.8045] [PMID: 29145229]
[http://dx.doi.org/10.11604/pamj.2018.30.301.14948] [PMID: 30637085]
[http://dx.doi.org/10.4081/monaldi.2018.898] [PMID: 29557575]
[http://dx.doi.org/10.1186/s12948-018-0099-2] [PMID: 30305804]
[http://dx.doi.org/10.21037/cdt.2018.03.07] [PMID: 29850410]
[http://dx.doi.org/10.1016/j.jaip.2018.01.033] [PMID: 29428243]
[http://dx.doi.org/10.1016/j.hrtlng.2018.03.014] [PMID: 29709318]
[http://dx.doi.org/10.1016/j.jemermed.2019.03.001] [PMID: 31003822]
[http://dx.doi.org/10.5543/tkda.2018.67055] [PMID: 31219450]
[PMID: 31050277]
[http://dx.doi.org/10.1007/s40292-019-00312-w] [PMID: 30912004]
[http://dx.doi.org/10.1093/ehjcr/ytaa002] [PMID: 33123674]
[http://dx.doi.org/10.2169/internalmedicine.5548-20] [PMID: 32963159]
[http://dx.doi.org/10.1177/2050313X20933104] [PMID: 32595973]
[http://dx.doi.org/10.2147/IJGM.S289015] [PMID: 33363401]
[http://dx.doi.org/10.1016/j.jaccas.2019.11.051] [PMID: 34316955]
[http://dx.doi.org/10.5152/AnatolJCardiol.2020.36422] [PMID: 34100733]
[http://dx.doi.org/10.1136/bcr-2020-240704] [PMID: 33649028]
[http://dx.doi.org/10.12890/2021_003006] [PMID: 34912743]
[http://dx.doi.org/10.1186/s12872-021-01936-4] [PMID: 33711934]
[http://dx.doi.org/10.1155/2021/4485754] [PMID: 34630571]
[http://dx.doi.org/10.3389/fcvm.2021.668318] [PMID: 34012985]
[PMID: 34735359]
[http://dx.doi.org/10.18176/jiaci.0723] [PMID: 34156959]
[http://dx.doi.org/10.7759/cureus.44704] [PMID: 37809202]
[http://dx.doi.org/10.1016/j.cjco.2023.07.009] [PMID: 37876888]
[http://dx.doi.org/10.1007/s00380-004-0804-6] [PMID: 16025365]
[PMID: 19746284]
[http://dx.doi.org/10.1016/j.ajem.2010.10.012] [PMID: 21159465]
[http://dx.doi.org/10.1080/08998280.2019.1581319] [PMID: 31191145]
[http://dx.doi.org/10.51894/001c.8999] [PMID: 33655161]
[http://dx.doi.org/10.1177/2048872616655943] [PMID: 27325844]
[http://dx.doi.org/10.4037/ajcc2009100] [PMID: 19556418]
[http://dx.doi.org/10.37179/rijccm.000005]
[http://dx.doi.org/10.1002/ams2.729] [PMID: 35223043]
[http://dx.doi.org/10.1002/ccr3.6781] [PMID: 36578798]
[http://dx.doi.org/10.1016/j.ijcard.2014.04.191] [PMID: 24801079]
[http://dx.doi.org/10.1016/j.redar.2012.02.012] [PMID: 22559993]
[http://dx.doi.org/10.1016/j.jemermed.2015.02.044] [PMID: 25989969]
[http://dx.doi.org/10.1016/j.hlc.2015.04.183] [PMID: 26138623]
[http://dx.doi.org/10.1503/cmaj.151314] [PMID: 27486207]
[http://dx.doi.org/10.1016/j.semerg.2015.11.007] [PMID: 26831543]
[PMID: 27020993]
[http://dx.doi.org/10.1016/j.jiph.2018.02.009] [PMID: 29534969]
[http://dx.doi.org/10.1016/j.hrtlng.2018.07.015] [PMID: 30245248]
[http://dx.doi.org/10.1016/j.cjca.2021.12.001] [PMID: 34902455]
[http://dx.doi.org/10.1186/s43044-021-00233-x] [PMID: 34928466]
[http://dx.doi.org/10.1016/j.ijcard.2008.08.026] [PMID: 18805597]
[http://dx.doi.org/10.7759/cureus.46297] [PMID: 37915873]
[http://dx.doi.org/10.1016/j.bjane.2013.06.015] [PMID: 24998115]
[http://dx.doi.org/10.1016/j.bjan.2013.07.008] [PMID: 26952229]
[http://dx.doi.org/10.1016/j.ijcard.2014.12.082] [PMID: 25577771]
[http://dx.doi.org/10.1186/s40981-019-0269-3] [PMID: 32026020]
[http://dx.doi.org/10.5935/0103-507X.20200021] [PMID: 32401974]
[http://dx.doi.org/10.14797/mdcvj.1084] [PMID: 35855403]
[http://dx.doi.org/10.5603/CJ.2023.0010] [PMID: 36861932]
[http://dx.doi.org/10.3390/diagnostics9040154] [PMID: 31635242]
[http://dx.doi.org/10.1016/j.jemermed.2019.03.026] [PMID: 31014971]
[http://dx.doi.org/10.1016/j.medcli.2018.02.006] [PMID: 29525117]
[http://dx.doi.org/10.3389/fcvm.2022.1061586] [PMID: 36465467]
[http://dx.doi.org/10.1016/j.rce.2011.10.008] [PMID: 22153584]
[http://dx.doi.org/10.1016/j.ijcard.2008.03.069] [PMID: 18632173]
[http://dx.doi.org/10.1016/j.cjca.2015.12.012] [PMID: 26947537]
[http://dx.doi.org/10.1097/MJT.0000000000000113] [PMID: 26938747]
[http://dx.doi.org/10.1016/j.ijcard.2016.08.247] [PMID: 27589045]
[http://dx.doi.org/10.1016/j.repc.2016.03.009] [PMID: 27865673]
[http://dx.doi.org/10.1016/j.jaip.2018.05.030] [PMID: 29902529]
[http://dx.doi.org/10.1213/XAA.0000000000000768] [PMID: 29621013]
[http://dx.doi.org/10.1111/imj.15226] [PMID: 33738953]
[http://dx.doi.org/10.12659/AJCR.934190] [PMID: 34807902]
[http://dx.doi.org/10.2169/internalmedicine.0802-18] [PMID: 30146563]
[http://dx.doi.org/10.1111/anec.12837] [PMID: 33783917]
[http://dx.doi.org/10.1007/s00059-013-3919-7] [PMID: 23907697]
[http://dx.doi.org/10.4103/1658-354X.177329] [PMID: 27833491]
[http://dx.doi.org/10.1016/j.jccase.2013.03.002] [PMID: 30546731]
[http://dx.doi.org/10.1097/MD.0000000000034535] [PMID: 37565887]
[http://dx.doi.org/10.3390/medicina58060759] [PMID: 35744022]
[http://dx.doi.org/10.1016/j.jccase.2021.06.001] [PMID: 35024063]
[http://dx.doi.org/10.1016/j.ijcard.2008.05.052] [PMID: 18804883]
[http://dx.doi.org/10.1016/S1875-4597(09)60007-2] [PMID: 19097966]
[http://dx.doi.org/10.2459/JCM.0b013e32833b97a9] [PMID: 20543709]
[http://dx.doi.org/10.1016/j.ijcard.2012.09.166] [PMID: 23141553]
[http://dx.doi.org/10.4097/kjae.2014.67.6.412] [PMID: 25558342]
[http://dx.doi.org/10.1177/1078155214563814] [PMID: 25870182]
[http://dx.doi.org/10.1213/XAA.0000000000000474] [PMID: 28181948]
[http://dx.doi.org/10.1155/2020/6590101] [PMID: 32128264]
[PMID: 32923101]
[http://dx.doi.org/10.1016/j.ajem.2011.11.011] [PMID: 22177586]
[http://dx.doi.org/10.4103/aca.aca_302_20] [PMID: 37706392]
[http://dx.doi.org/10.28982/josam.402775]
[http://dx.doi.org/10.18176/jiaci.0091] [PMID: 27763868]
[http://dx.doi.org/10.1155/2019/6317956] [PMID: 31341482]
[PMID: 24511660]
[http://dx.doi.org/10.1016/j.cjca.2018.08.029] [PMID: 30527164]
[http://dx.doi.org/10.4103/0970-9185.209737] [PMID: 28781470]
[http://dx.doi.org/10.18176/jiaci.0884] [PMID: 36811839]
[http://dx.doi.org/10.1016/j.ijcard.2007.12.075] [PMID: 18378025]
[http://dx.doi.org/10.1007/s00392-012-0504-7] [PMID: 22878733]
[http://dx.doi.org/10.1016/j.jcin.2014.05.031] [PMID: 25459048]
[http://dx.doi.org/10.1159/000490182] [PMID: 29913447]
[http://dx.doi.org/10.1080/08998280.2021.1907095] [PMID: 34219938]
[http://dx.doi.org/10.1016/j.ejro.2019.02.004] [PMID: 30805421]
[http://dx.doi.org/10.1016/j.cjco.2021.11.003] [PMID: 35386129]
[http://dx.doi.org/10.18999/nagjms.84.3.664] [PMID: 36237895]
[http://dx.doi.org/10.1093/ehjcr/ytz143] [PMID: 31660504]
[http://dx.doi.org/10.1016/j.ajem.2020.01.033] [PMID: 31983596]
[http://dx.doi.org/10.1186/s40981-020-00326-7] [PMID: 32124089]
[http://dx.doi.org/10.18176/jiaci.0248] [PMID: 30073957]
[http://dx.doi.org/10.1136/bcr-2017-222846] [PMID: 29348285]
[http://dx.doi.org/10.1016/j.jclinane.2018.03.017] [PMID: 29660702]
[http://dx.doi.org/10.1016/j.redare.2017.12.014] [PMID: 29361310]
[http://dx.doi.org/10.1016/j.ijcard.2016.05.058] [PMID: 27236126]
[http://dx.doi.org/10.1016/j.redare.2018.08.009] [PMID: 30290961]
[http://dx.doi.org/10.7759/cureus.6972] [PMID: 32190518]
[http://dx.doi.org/10.18176/jiaci.0645] [PMID: 32985984]
[http://dx.doi.org/10.1016/j.ijcard.2019.06.002] [PMID: 31204069]
[http://dx.doi.org/10.1016/j.ijcard.2018.07.119] [PMID: 30057169]
[http://dx.doi.org/10.3390/vaccines10010038] [PMID: 35062699]
[http://dx.doi.org/10.1007/s40521-023-00342-9] [PMID: 37361641]
[http://dx.doi.org/10.4049/jimmunol.138.7.2184] [PMID: 3549898]
[http://dx.doi.org/10.1515/cclm-2016-0010] [PMID: 26966931]