Akita Tomomi, Kawata Masahito, Sakaguchi Ayu, Kato Yukinori, Suehiro Hideya, Takada Hiroki, Matsuura Takeshi, Kamemura Kohei, Hirayama Yasutaka, Adachi Kazumasa, Matsuura Akira, Sakamoto Susumu
Department of Cardiology, Akashi Medical Center, Akashi, Japan.
J Cardiol Cases. 2015 Dec 8;13(2):47-51. doi: 10.1016/j.jccase.2015.10.001. eCollection 2016 Feb.
We experienced a case of Kounis syndrome with cardiopulmonary arrest and severe coronary spasm. A 70-year-old man with cardiac pacemaker and chronic dialysis was treated for angina pectoris of the right coronary artery. After diagnostic coronary angiography of the right coronary artery, optical coherence tomography was performed with contrast medium and low-molecular-weight dextran. The patient's blood pressure unexpectedly dropped to 40 mmHg and erythema of the breast was noted. Electrocardiogram showed remarkable ST elevation in II, III, aVF leads. Coronary angiography showed total occlusion of the proximal right coronary artery. Although intracoronary infusion of sodium nitrate did not dilate the coronary artery promptly, coronary balloon angioplasty recovered the artery flow. Since severe anaphylaxis-related shock was contemplated, methyl prednisolone and epinephrine were administered intravenously. We could not introduce percutaneous cardiopulmonary support due to kinking of the vein. After 1 hour of cardiopulmonary resuscitation with frequent ventricular fibrillation and direct current shock, the sinus rhythm and blood pressure recovered. Following 2 months of intensive care treatment for other complications, including infection, the patient was discharged from hospital without any residual disability. < An anaphylactic reaction is one of the causes of sudden deterioration of a patient's condition observed during interventional procedures. Kounis syndrome is a rare and not yet well known important concept that deals with the reaction. Therefore, we report a severe case of Kounis syndrome with cardiopulmonary arrest.
我们遇到了一例伴有心肺骤停和严重冠状动脉痉挛的库尼斯综合征病例。一名患有心脏起搏器且长期透析的70岁男性因右冠状动脉心绞痛接受治疗。在对右冠状动脉进行诊断性冠状动脉造影后，使用造影剂和低分子右旋糖酐进行了光学相干断层扫描。患者血压意外降至40 mmHg，并发现胸部出现红斑。心电图显示II、III、aVF导联ST段显著抬高。冠状动脉造影显示右冠状动脉近端完全闭塞。尽管冠状动脉内注入硝酸钠未能迅速扩张冠状动脉，但冠状动脉球囊血管成形术恢复了动脉血流。由于考虑到严重的过敏反应性休克，静脉注射了甲泼尼龙和肾上腺素。由于静脉扭结，我们无法实施经皮心肺支持。在经历了1小时伴有频繁室颤和直流电除颤的心肺复苏后，窦性心律和血压恢复。在对包括感染在内的其他并发症进行了2个月的重症监护治疗后，患者出院，无任何残留残疾。<过敏反应是介入手术期间观察到的患者病情突然恶化的原因之一。库尼斯综合征是一个罕见且尚未广为人知的重要概念，涉及这种反应。因此，我们报告了一例伴有心肺骤停的严重库尼斯综合征病例。
