TY - JOUR
T1 - A Male Patient with Syncope, Anaphylaxis, and ST-Elevation
T2 - Hepatic and Cardiac Echinococcosis Presenting with Kounis Syndrome
AU - Mirijello, Antonio
AU - Pepe, Gaetano
AU - Zampiello, Patrizio
AU - Criconia, Giovanni Marco
AU - Mendola, Angela
AU - Manfrini, Antonio
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Background Approximately 1% of emergency department (ED) visits are due to anaphylaxis. Symptoms can include skin rash, facial and laryngeal edema, dyspnea, vomiting, hypotension, and shock. A transient loss of consciousness can also be a manifestation of anaphylaxis. A variety of electrocardiographic changes due to anaphylaxis have been described for Kounis syndrome, also known as allergic angina. Case Report Here we describe the case of a male patient presenting at an ED with syncope, anaphylactic shock, and ST-segment elevation on electrocardiogram (ECG). The diagnostic workup led to the diagnosis of ruptured hepatic echinococcal cyst complicated by anaphylactic shock and syncope. ECG alterations were a manifestation of anaphylaxis, as defined by the type I Kounis syndrome. Why Should an Emergency Physician Be Aware of This? Kounis syndrome represents an underestimated disease. Its prompt diagnosis in an ED has important clinical and therapeutic implications, such as modifications in the anaphylaxis treatment protocol, that is, adrenaline should be avoided because it could worsen vasospasm and myocardial ischemia.
AB - Background Approximately 1% of emergency department (ED) visits are due to anaphylaxis. Symptoms can include skin rash, facial and laryngeal edema, dyspnea, vomiting, hypotension, and shock. A transient loss of consciousness can also be a manifestation of anaphylaxis. A variety of electrocardiographic changes due to anaphylaxis have been described for Kounis syndrome, also known as allergic angina. Case Report Here we describe the case of a male patient presenting at an ED with syncope, anaphylactic shock, and ST-segment elevation on electrocardiogram (ECG). The diagnostic workup led to the diagnosis of ruptured hepatic echinococcal cyst complicated by anaphylactic shock and syncope. ECG alterations were a manifestation of anaphylaxis, as defined by the type I Kounis syndrome. Why Should an Emergency Physician Be Aware of This? Kounis syndrome represents an underestimated disease. Its prompt diagnosis in an ED has important clinical and therapeutic implications, such as modifications in the anaphylaxis treatment protocol, that is, adrenaline should be avoided because it could worsen vasospasm and myocardial ischemia.
KW - anaphylactic shock
KW - Kounis syndrome
KW - non-ischemic ST-elevation
KW - syncope
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U2 - 10.1016/j.jemermed.2016.06.011
DO - 10.1016/j.jemermed.2016.06.011
M3 - Article
AN - SCOPUS:84995629529
VL - 51
SP - e73-e77
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
SN - 0736-4679
IS - 4
ER -