Cardiogenic Shock due to Kounis Syndrome following Cobra Bite

Kounis syndrome is associated with mast cell activation resulting in acute coronary syndrome secondary to an allergic insult. Various drugs such as antibiotics, analgesics, and environmental exposures such as bee, wasp sting, and poison ivy are known to induce Kounis syndrome. A 68-year-old man admi...

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Published inCase Reports in Critical Care Vol. 2019; no. 2019; pp. 1 - 3
Main Authors Snajeeva, E., Vithanage, K. S., Ranaweera, A. G. R. M. A., Gunapala, A., Manoj, E. M., Priyankara, W. D. D., Sivasubramanium, M.
Format Journal Article
LanguageEnglish
Published Cairo, Egypt Hindawi Publishing Corporation 2019
Hindawi
John Wiley & Sons, Inc
Hindawi Limited
Subjects
Acute coronary syndromes
Allergies
Angina pectoris
Antibiotics
Bites and stings
Cardiogenic shock
Cardiology
Cardiovascular disease
Case Report
Case reports
Complications and side effects
Coronary vessels
Critical care
Ejection fraction
Electrocardiogram
Electrocardiography
Emergency medicine
Epidemiology
Heart attacks
Immunoglobulin E
Internal medicine
Patients
Poisonous snakes
Snakes
Thrombosis
Venom
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Summary:Kounis syndrome is associated with mast cell activation resulting in acute coronary syndrome secondary to an allergic insult. Various drugs such as antibiotics, analgesics, and environmental exposures such as bee, wasp sting, and poison ivy are known to induce Kounis syndrome. A 68-year-old man admitted with a cobra bite on both hands to emergency care unit and sustained cardiorespiratory arrest. Electrocardiogram, taken 6 hours after the cardiac arrest, showed ST elevations in leads V2 to V5 suggestive of anterior ST elevation myocardial Infarction (STEMI). Serum Troponin was 10 ng/ml (control= <0.5). Serum IgE levels were significantly high (19155IU/ml, baseline 100). 2-Dimensional echocardiogram showed anterior and apical-septal hypokinesia with left ventricular ejection fraction of 30-35%. Coronary angiogram was normal. He remained hypotensive requiring inotropic and vasopressor support during ICU stay. This was a case of Kounis syndrome leading to cardiogenic shock secondary to Cobra (naja naja) bite. This is the only reported case of cobra bite causing Kounis syndrome and cardiogenic shock. Identification of the cause of myocardial infarction in snake envenomation is useful in the management as some of the drugs like adrenaline, morphine, and beta blockers may worsen the clinical syndrome if it is due to Kounis syndrome.
Bibliography:Academic Editor: Kurt Lenz
ISSN:2090-6420
2090-6439
DOI:10.1155/2019/5185716