Combined etiology of anaphylactic cardiogenic shock: Amiodarone, epinephrine, cardioverter defibrillator, left ventricular assist devices and the Kounis syndrome.
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Date
2015-04
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Abstract
Anaphylactic shock is a life‑threatening condition which needs detailed and mediculous clinical assessment
and thoughtful treatment. Several causes can join forces in order to degranulate mast cells. Amiodarone
which is an iodine‑containing highly lipophilic benzofuran can induce allergic reactions and anaphylactic
shock in sensitized patients. Epinephrine is a life saving drug, but in sulfite allergic patients it should be given
with caution due its metabisulfite preservative. Metals covering cardiac defibrillators and pacemakers can
act as antigens attached to serum proteins and induce allergic reactions. In anaphylactic shock, myocardial
involvement due to vasospasm‑induced coronary blood flow reduction manifesting as Kounis syndrome
should be always considered. Clinically, combined treatment targeting the primary cause of anaphylaxis
together with protection of cardiac tissue seems to be of paramount importance.
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Keywords
Anaphylactic shock, amiodarone, cardioverter defibrillator, epinephrine, Kounis syndrome, left ventricular assist device
Citation
Kounis Nicholas G, Soufras George D, Davlouros Periklis, Tsigkas Grigorios, Hahalis George. Combined etiology of anaphylactic cardiogenic shock: Amiodarone, epinephrine, cardioverter defibrillator, left ventricular assist devices and the Kounis syndrome. Annals of Cardiac Anaesthesia. 2015 Apr; 18(2): 261-264.