ReviewJournal of thrombosis and thrombolysis2021
The allergic myocardial infarction dilemma: is it the anaphylaxis or the epinephrine?
Review in Journal of thrombosis and thrombolysis, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 19 citations in OpenAlex.
- Type II Kounis Syndrome Secondary to Amoxicillin Allergy.JACC. Case reports · 2026Article
- Successful management of protracted anaphylaxis-induced severe acute respiratory distress syndrome masquerading as non-ST elevation myocardial infarction: a rare case report.BMC cardiovascular disorders · 2026Article
- Liposomal Delivery of Allolobophora caliginosa Coelomic Fluid Attenuates Myocardial Infarction by Suppressing Oxidative Damage, Inflammation, and Apoptosis.Applied biochemistry and biotechnology · 2025Article
- Case Report: Anaphylactic shock and ST-elevation myocardial infarction following a bee sting: two deadly diseases in a patient with Kounis syndrome.Frontiers in cardiovascular medicine · 2025Article
- Cytokine Storms and Anaphylaxis Following COVID-19 mRNA-LNP Vaccination: Mechanisms and Therapeutic Approaches.Diseases (Basel, Switzerland) · 2024Review
- An Insight into Kounis Syndrome: Bridging Clinical Knowledge with Forensic Perspectives.Life (Basel, Switzerland) · 2024Review
- ATAK complex (adrenaline, takotsubo, anaphylaxis, and kounis hypersensitivity-associated coronary syndrome) related to latamoxef administration-a case report.Frontiers in cardiovascular medicine · 2024Article
- Article
- Case report: Cefoperazone-sulbactam induced Kounis syndrome and cardiogenic shock.Frontiers in cardiovascular medicine · 2022Article
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
We highlight two distinct cases of myocardial infarction occurring concurrently with anaphylaxis at our centre in Singapore. The first case had cardiac symptoms and electrocardiogram changes concomitant with his anaphylaxis presentation, suggestive of Kounis syndrome, while the second case presented with anaphylaxis and only developed cardiac symptoms and electrocardiogram changes after treatment with intramuscular epinephrine, suggestive of epinephrine-induced myocardial infarction. Both these conditions are uncommon and under-recognised, and we review the current literature to compare the similarities and differences in their clinical manifestations, pathophysiology, and management. Kounis syndrome occurs secondary to mast cell degranulation ultimately resulting in coronary vasospasm, platelet activation and inflammatory response, whereas epinephrine causes platelet aggregation. Therefore, treatment priorities of Kounis syndrome are treatment of allergy, treatment of vasospasm, and treatment with anti-platelet therapy and revascularization if coronary plaques are present. For epinephrine-induced myocardial infarction, after epinephrine treatment is discontinued, considerations in management are re-vascularisation or pharmacotherapy. Further research will help with better understanding of both conditions and formulation of clinical management guidelines.
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