ACUTE CORONARY SYNDROME AFTER HORNET BITE, TYPE II KOUNIS SYNDROME – A CASE REPORT
Autori:
Hajriz Alihodžić, Boris Ilić, Nada Mladina, Denis Mršić
Sažetak
Kounisov sindrom je slučajna pojava akutnoga koronarnog sindroma povezan s anafilaksijom u kojoj akutni upalni medijatori dovode do spazma koronarnih arterija s erozijom i rupturom ateromatozne ploče. Prikazan je 53-godišnji muškarac poslije uboda stršljena u kojeg se u toku tretmana anafilaksije razvio akutni infarkt miokarda anteroseptalne lokalizacije. Dijagnoza Kounisova sindroma tipa II dokazana je elektrokardiografskim promjenama i biokemijskim markerima uz kliničku manifestaciju akutnoga koronarnog sindroma, a povezana je s anafilaksijom zbog koje je započet prehospitalni tretman bolesnika poslije uboda stršljena. Za anafilaksije poslije uboda stršljena potrebno je na vrijeme pomisliti na akutni koronarni sindrom ako bolesnici imaju bol u prsima i hemodinamski poremećaj jer se ova stanja rijetko događaju, a zahtijevaju dodatnu dijagnostiku i primjenu odgovarajućeg liječenja.
Summary
Kounis syndrome is an accidental occurrence of acute coronary syndrome associated with anaphylaxis, where acute inflammatory mediators cause the spasm of coronary arteries with the erosion and rupture of atheromatous plaque. We present a 53-year-old male who during the treatment of anaphylaxis after a hornet bite developed acute anteroseptal myocardial infarction. The diagnosis of type II Kounis syndrome was proven by electrocardiographic abnormalities and biochemical markers with clinical manifestation of acute coronary syndrome, and was associated with anaphylaxis which demanded prehospital treatment of the patient after the hornet bite. Anaphylaxis after a hornet bite requires consideration of acute coronary syndrome if patients have chest pain and hemodynamic impairment, as these conditions occur infrequently but demand additional diagnostics and adequate treatment.
