Published date: Sep 09 2021

Journal Title: ESPOCH Congresses: The Ecuadorian Journal of S.T.E.A.M.

Issue title: Volume 1, Issue 6

Pages: 1713–1722

DOI: 10.18502/espoch.v1i6.9663

Ángel Javier Peñafiel Chávezfiel@espoch.edu.ecDepartamento de Medicina, Facultad de Salud Pública, Escuela Superior Politécnica de Chimborazo, Riobamba, Ecuador

Alpha Baba DioubateDepartamento Médico, Centro de Especialidades Médicas CARDIOPIEL, Riobamba, Ecuador

Jessica Magali Herrera AbarcaDepartamento de Medicina, Facultad de Salud Pública, Escuela Superior Politécnica de Chimborazo, Riobamba, Ecuador

Magali Herrera AbarcaDepartamento de Medicina, Facultad de Salud Pública, Escuela Superior Politécnica de Chimborazo, Riobamba, Ecuador

Mauricio Tomas Rivas ContrerasDepartamento Médico, Clínica Dermatológica del Norte, Ovalle, Chile

Kounis syndrome is the grouping of an acute coronary artery disease associated with an anaphylactic allergy, in which there is an antigen-antibody reaction caused by the release of inflammatory mediators and mast cells act by causing degranulation, and in this situation there is the presence of cells of inflammation, causing an anaphylactic reaction. There are several triggers that can trigger an allergic reaction and therefore Kounis syndrome, patients with atopy are more susceptible, it has been associated with insect bites, medications and some foods, environmental contamination and some medical conditions. Any age because it has been described even in children. There are not many clinical studies, nor a larger sample of patients to reach a consensus on this pathology. We present a 46-year-old patient who is admitted to the Emergency service of the national institute of cardiology and cardiovascular surgery in Havana. Cuba; with a history of Systemic Arterial Hypertension (HT), which is an increase in blood  pressure above the upper limits of normality. Grade II obesity, which is a body mass index ≥35. In addition to referred dyslipidemia. In the results according to the diagnostic criteria of Kounis syndrome, the following were found: Signs and symptoms of myocardial ischemia, urticaria, pruritus, dyspnea, sinus tachycardia after bee sting. Electrocardiogram (ECG): With ST segment elevation in 2 or more continuous leads. Echocardiography: Transient segmental motility disorders. Cardiac chambers of preserved size and function. Serum myocardial biomarkers within normal parameters, increased Histamine, Tryptase, leukotriene values. The objective is to describe the clinical characteristics, complementary examinations, their diagnosis, evolution and treatment. It was concluded that the diagnosis of Kounis syndrome is eminently clinical. in itself everything that leads to the activation of mast cells can produce the syndrome. The prognosis depends on the type of Kounis, cardiovascular risk factors and pre‐existing coronary artery disease.

Keywords: ischemia, inflammatory response, angina, vasospasm, atherosclerosis, histamine.

RESUMEN

El síndrome de Kounis es la agrupación de una arteriopatía coronaria aguda asociado a una alergia anafiláctica, en la que hay una reacción antígeno-anticuerpo causado por la liberación de mediadores inflamatorios los mastocitos y estos actúan provocando degranulación, y ante esta situación hay presencia de células de la inflamación, provocando una reacción anafiláctica. Existen varios gatillantes que pueden desencadenar una reacción alérgica y por ende el síndrome de Kounis, son más susceptibles los pacientes con atopia, se le ha relacionado mucho con picaduras de insectos, medicamentos y algunos alimentos, contaminación ambiental y algunas condiciones médicas Se puede presentar a cualquier edad porque se ha descrito incluso en niños. No hay muchos estudios clínicos, ni una muestra más grande de pacientes para realizar un consenso de esta patología. Presentamos una paciente de 46 años de edad que es ingresada al servicio de Emergencia del instituto nacional de cardiología y cirugía cardiovascular de la habana. Cuba; con antecedente de Hipertensión Arterial Sistémica (HTA) que es aumento de la presión arterial por encima de los limites superiores de normalidad. Obesidad grado II que es el índice de masa corporal ≥ 35. además de dislipidemia referida. En los resultados según los criterios diagnóstico del síndrome de Kounis se encontró: Signos y síntomas de isquémica miocárdica, urticaria, prurito, disnea, taquicardia sinusal tras picadura de una abeja. Electrocardiograma (ECG): Con elevación del segmento ST en 2 o más derivaciones continuas. Ecocardiografía: Trastornos de motilidad segmentaria transitorio. cavidades cardiacas de tamaño y función conservada. Los biomarcadores miocárdicos sérico dentro de los parámetros normales, incremento de los valores de Histamina, Triptasa, leucotrienos. El objetivo es describir las características clínicas, exámenes complementarios, su diagnóstico, evolución y tratamiento. Se concluyó que el diagnóstico del síndrome de Kounis es eminentemente clínico. en sí todo lo que conlleve a la activación de mastocitos puede producir el síndrome. El pronóstico depende del tipo de Kounis, de los factores de riesgos cardiovasculares y coronariopatía preexistente.

Palabras claves: isquemia, respuesta inflamatoria, angina, vasoespasmo, ateroesclerosis, histamina.

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