Table 1.
The reported cases of Kounis syndrome induced by contrast media.
| Study | Sex | Age (years) |
History of Allergy/Cardiac Diseases | Trigger-to-Onset Time | Clinical Presentation | Type of KS | ECG Manifestation | Diagnostic Method | Treatment | Cardiac Complications | Contrast Agent |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Park JM et al. [29] | Male | 54 | DM; asymptomatic coronary disease; allergy (-) |
30 min (CTCA) | Chest pain; flushing; shortness of breath |
II | ST elevation (precordial) | CAG; CTCA | Methylprednisolone; chlorpheniramine; cimetidine; morphine; heparin; aspirin; clopidogrel; stenting | Hypotension | Unknown |
| Oh KY et al. [30] | Male | 74 | Nausea and vomiting to CM | After administration (CT) | Loss of consciousness | I | ST elevation (II, III, and aVF) | CAG (normal) | Adrenaline; chlorpheniramine; methylprednisolone | Cardiac arrest | Iopromide |
| Kogias JS et al. [31] | Male | 48 | Heavy smoker; MI (post-DES); allergy (-) | 10 min (CT) | Paleness; dizziness; retrosternal discomfort | III | ST elevation (I and aVL); precordial acute T waves | Troponin I; cardiac enzymes; CAG | Hydrocortisone; diphenhydramine; ranitidine; heparin; nitroglycerin; stenting | AMI (intrastent stenosis) | Iopromide (Ultravist) |
| Wang CC et al. [32] | Male | 73 | Smoker; angina; right CCA stenosis; allergy (-) | Immediately (CAG) | Dyspnea; dizziness; cold sweat; blurred vision | I | Unknown | CAG (complete occlusion of LAD and LCX) | IABP; intracoronary nitrates; hydrocortisone; diphenhydramine; fluid therapy; blood transfusion; dopamine; adrenaline | VF; VT; complete AV block; AMI | Iohexol (Omnipaque) |
| Wang CC et al. [32] | Male | 64 | MI (anterior, post-PCI) | Immediately (CAG) | Respiratory distress; angioedema; skin rashes | I | Unknown | CAG (complete occlusion of RCA) | Intubation; mechanical ventilation; fluid therapy; dopamine; IABP; intracoronary nitrates; hydrocortisone; diphenhydramine; adrenaline | Hypotension | Iohexiol |
| Kocabay G et al. [33] | Male | 62 | Pancreatic cancer; allergy (-) | During infusion (CT) | Nausea; loss of consciousness; no pulse | I | ST elevation (II, III, aVF, and precordial) | ECG | Adrenaline | Hypotension | Iohexol |
| Yanagawa Y et al. [34] | Male | 51 | DM; hypertension; chest pain (inferior wall ischemia, suspected by SPECT); allergy (-) | 10 min (CAG) | Chest pain; generalized urticaria; itching; chills | II | ST elevation (anterior) | CAG (complete occlusion of the mid-segment of LCA); prick test | Stenting; steroid; anti-histamine | VF | Iopromide (Ultravist) |
| Zlojtro M et al. [35] | Female | 46 | DM; prolactinoma; allergy to CM; antibiotics | 10 min (MRI) | Generalized urticaria; angioedema | I | ST elevation (inferolateral) | CAG (normal) | Methylprednisolone (pre-medication); adrenaline; chloropiramine chloride; methylprednisolone; fluid therapy | Hypotension | Gadoterate meglumine (Dotarem) |
| Del Furia F et al. [36] | Male | 61 | Chest pain at rest; smoker; allergy (-) | A few min (CAG) | Diffuse erythema; chest pain | II | ST elevation (V1–V5) | CAG (complete occlusion of LAD and diffuse vasospasm of LCX) | Hydrocortisone; hydroxyzine; noradrenaline; fluid therapy; stenting | Hypotension | Unknown |
| Hamilos MI et al. [37] | Male | 51 | Smoker; hyperlipidemia; allergy to aspirin and agricultural chemicals | 90 min (CAG) | Chest pain; nausea; sweating | I | ST elevation (II, III, and aVF) | CAG (complete occlusion of RCA due to vasospasm) | Corticosteroids; antihistamine; intravenous nitrates; heparin; intracoronary nitrates | AMI (vasospasm; mild elevation of cardiac enzymes) | Unknown |
| Present case | Male | 60 | MI (inferoposterior; post-PCI); allergy to CM |
After administration (CT) | Feeling unwell; numbness of upper limbs; dyspnea; loss of consciousness | II | ST elevation (II, III, and aVF); acute T waves (precordial leads) | ECG | Adrenaline; fluid therapy; hydrocortisone; heparin; nicorandil | Hypotension | Iopamidol |
KS, Kounis syndrome; ECG, electrocardiography; CT, computed tomography; DM, diabetes mellitus; CTCA, CT coronary angiography, CAG, coronary angiography; AMI, acute myocardial infarction; CM, contrast media; MI, myocardial infarction; DES, drug-eluting stent; CCA, common carotid artery; LAD, left anterior descending artery; LCX, left circumflex artery; IABP, intraaortic balloon pumping; PCI, percutaneous coronary intervention; VF, ventricular fibrillation; VT, ventricular tachycardia; AV, atrioventricular; RCA, right coronary artery; SPECT, single-photon emission computed tomography; MRI, magnetic resonance imaging.