■肾上腺素,应激性心肌病,过敏反应,和Kounis综合征(肾上腺素,Takotsubo,过敏反应,Kounis情结,ATAK)构成一种复杂的临床综合征,通常与内源性或外源性肾上腺素有关。由于它的快速发作,严重程度,和治疗挑战,它值得临床医生的极大关注。本文报道了1例II型Kounis综合征合并由latamoxef引起的过敏引发的应激性心肌病(ATAK)。
一名67岁男性慢性阻塞性肺疾病急性加重患者入院呼吸内科治疗。出院前一天,在接受latamoxef输注27分钟后,病人出现喘息,呼吸困难,发冷,大量出汗,体温升高,需要转移到ICU进行监测和治疗。心电图提示疑似心肌梗塞,床旁超声心动图显示左心室射血分数为40%,左心室节段功能障碍,和顶端四舍五入。急诊冠状动脉造影显示左前降支和右冠状动脉中段有50%的节段性偏心狭窄。最终诊断为II型Kounis综合征合并因latamoxef引起的过敏引起的应激性心肌病,即,ATAK.尽管积极治疗,患者在ICU第3天死于严重心源性休克.
■ATAK是一个进展迅速的临界条件。对于出现严重过敏反应的患者,监测生物标志物如肌钙蛋白和心电图的变化对于及时识别至关重要。如果一个病人被诊断为库尼斯综合征,应谨慎使用肾上腺素以预防ATAK。
UNASSIGNED: Adrenaline, stress cardiomyopathy, allergic reactions, and Kounis syndrome (
Adrenaline, Takotsubo, Anaphylaxis, Kounis Complex, ATAK) constitute a complex clinical syndrome often associated with endogenous or exogenous
adrenaline. Due to its rapid onset, severity, and treatment challenges, it warrants significant attention from clinicians. This article reports a case of Type II Kounis syndrome combined with stress cardiomyopathy (ATAK) triggered by a latamoxef-induced allergy.
UNASSIGNED: A 67-year-old male patient with an acute exacerbation of chronic obstructive pulmonary disease was admitted to the respiratory department for treatment. The day before discharge, after receiving a latamoxef infusion for 27 min, the patient developed wheezing, dyspnea, chills, profuse sweating, and an elevated body temperature, necessitating transfer to the ICU for monitoring and treatment. The ECG suggested a suspected myocardial infarction, while bedside echocardiography showed a left ventricular ejection fraction of 40%, segmental dysfunction of the left ventricle, and apical rounding. Emergency coronary angiography revealed 50% segmental eccentric stenosis in the mid-segment of the left anterior descending branch and right coronary artery. The final diagnosis was Type II Kounis Syndrome combined with stress cardiomyopathy due to a latamoxef-induced allergy, i.e., ATAK. Despite aggressive treatment, the patient succumbed to severe cardiogenic shock on the third day in the ICU.
UNASSIGNED: ATAK is a critical condition that progresses rapidly. For patients experiencing severe allergic reactions, monitoring biomarkers such as Troponin and ECG changes is crucial for timely recognition. If a patient is diagnosed with Kounis syndrome, caution should be exercised in using
adrenaline to prevent ATAK.