Acute coronary syndrome that occurs during an immune-mediated hypersensitivity reaction or maybe not.

There are 3 types:

-        type I: angina associated with coronary spasm

-        type II: myocardial infarction caused by rupture of atherosclerotic plaque

-        type III: a pharmacologically active coronary stent thrombosis.

Although the majority of cases have been described in adults, some pediatric cases have been observed (the youngest: 2 years). The richness of the myocardium in mast cells explains this cardiac pathology associated with the release of histamine and leukotrienes.

Clinical picture: hypersensitivity reaction accompanied by angina or, under anesthesia, of changes in the ST segment (STEMI), or of the T wave, arrhythmia, enlargement of the QT. Echography: regional contractility disorders, sometimes apical bloating of the VG (see Takotsubo)

Treatment: of the hypersensitivity by titrating a dose of adrenaline to avoid aggravating myocardial ischemia. Type I: intracoronary injection of calcium channel blockers, type II thrombolysis. Type III aspiration of thrombus that clogs the stent.

Anesthetic implications:

keep that possibility in mind in case of anaphylactic reaction

References : 

-         Biteker M, Duran NE, Biteker FS, Erturk E, Aykan AC et al.
Kounis syndrome secondary to amoxicillin/clavulanic acid use in a child.
Int J Cardiol 2009; 2: 583-93

-        Parent B, Wearden P, Kounis NG et al.
Kounis syndrome or allergic vasospasm in a two-year-old.
Congenit Heart Dis 2011; 65:: 499-503

-        Fourie P.
Kounis syndrome : a narrative review.
South Afr J Anaesth Analg; 2016; 22:72-80

Updated: July 2016