Kounis syndrome can explain vaccine-related heart attacks

I recently talked to a nurse from a local hospital. He said they see more cases of young people with chest pains of unknown etiology in their hospital this year. He thinks it is strange.

An emergency room physician also told me about several cases of shortness of breath and chest pains that present to his busy emergency room. Many of them have a negative workup for heart and lungs problems. What could they be?

Kounis Syndrome

Kounis syndrome, also known as Allergic Angina and Allergic Myocardial Infarction, is when an allergic or hypersensitivity reaction leads to spasms or constriction of the coronary arteries and presents as chest pain. [6] Angina is chest pain caused by a decrease in blood supply to the heart. Kounis Syndrome can range from chest pain that improves on its own to a full-blown heart attack and sudden death.

Allergens are substances that can cause an allergic reaction. Allergens are different from person to person. They can be due to medications, metal, the environment, food, and biological fluids containing the allergen. [2] [3]

Ingredients in vaccines can be an allergen.

Potential Allergens in COVID-19 vaccines

Polyethylene glycol (PEG) and polysorbate are used to improve water solubility in drugs. They are the leading potential allergenic/immunogenic excipients in COVID-19 vaccines. [9]

PEG is used in various laxatives (Miralax, for example) and injectable formulations, such as depot steroids. Previous allergies to the PEG can induce an allergic reaction to the mRNA vaccines.

A form of PEG, macrogol, has been used for the first time in both the Pfizer-BioNTech and Moderna COVID-19 mRNA to stabilize the lipid nanoparticles that contain the mRNA. [8]

The AstraZeneca vaccine and the Johnson & Johnson use polysorbate 80, also known as Tween 80, and do not contain PEG.

Polysorbate is structurally similar to PEG and presents clinical cross-reactivity with PEG. If someone is allergic to polysorbate, they can develop an allergic reaction to Tween 80. Suppose one developed an allergic reaction to the Johnson and Johnson vaccine and decided to take the Moderna or Pfizer vaccine for a second or for the booster shot. In that case, the cross-reactivity can potentially cause an allergy.

Creams, ointments, lotions, and other cosmetics can contain polysorbate. People who use them may get sensitized to polysorbate and develop adverse reactions when exposed to the polysorbate in the vaccines.

1–5.4% of the population is already sensitized to cosmetics or cosmetic ingredients, according to estimates. [8]

Mechanism of Kounis Syndrome

Inflammatory mediators are increased in allergic reactions and acute coronary syndromes. These mediators are released from mast cells if an allergen is present.

An acute coronary syndrome is “an umbrella term for where the blood supplied to the heart muscle is suddenly blocked.”

The release of mediators during allergic insults induces coronary artery spasm or atheromatous plaque erosion or rupture. [4]. Coronary arteries supply blood to the heart muscles. Spasms of the coronaries reduce blood supply to the heart, and chest pain will occur. Sometimes a sudden death can occur.

Allergic Angina

People without cholesterol plaques in their coronaries can have chest pains due to coronary spasms from an allergy. A typical example will be a person who had chest pains with an abnormal EKG and cardiac enzymes but does not have the usual risk factors like diabetes, high blood pressure, high cholesterol, and obesity.

Their stress test will be unremarkable once the spasms have subsided, and their coronary angiogram, which is an imaging of the coronaries, will not show any blockage.

Kounis Syndrome and Heart Attacks

Coronary arterial spasms can also rupture a stable cholesterol plaque inside the coronaries. A blood clot forms around the ruptured plaque and blocks the blood flow leading to a heart attack.

Two Cases of Kounis Syndrome Post Vaccination

A case report from Turkey is about a 41-year-old woman with no cardiovascular risk factors admitted to the emergency department with flushing, palpitation, dyspnea, and chest pain 15 minutes after the first dose of inactivated CoronaVac (Sinovac China).

Kounis Syndrome was the diagnosis. Her EKG was abnormal, and an echocardiogram showed diminished pumping of the heart. The serum troponin level was high, indicating heart inflammation. Fortunately, she was discharged from the hospital in good condition.

A report from Poland is about an 86 year old man on a blood thinner called apixaban due to atrial fibrillation. Atrial fibrillation or Afib is a heart condition that causes irregular heart rhythm. Afib can cause blood clots inside the heart, and the clot can break off and go to the brain and lead to a stroke. That is why a blood thinner is needed.

The patient went to have his first dose of the Pfizer–BioNTech vaccine. About 30 minutes after, the patient collapsed. EKG showed an acute heart attack. He was brought to the hospital, where he immediately got a coronary angiogram. Clots entirely blocked three vessels. The cardiologist reopened the blockages. But sadly, the patient passed away on the third day.

Based on the appearance of the other coronaries, which were fully open. The cardiologist’s impression is that the clots blocking the coronaries happened suddenly due to Kounis syndrome. [10] What is significant is that even though the patient is on a blood thinner, a blood clot could still form.

Heart Attacks and Anaphylaxis reported to VAERS

adverse effects to vaccinations are reported to the Vaccine Adverse Effect Reaction System or VAERS. Anyone can report to VAERS. Reporting does not necessarily mean that it was the vaccine that caused the adverse effect.

OPENVAERS is another website that presents the VAERS data in a more accessible form. Below is their data as of Oct 15, 2021. Notice the 7,532 cases of anaphylaxis.

Below is from the same web page. Look at the 8,408 reported heart attacks and 31,753 cases of severe allergic reactions.

How many of those 8,408 heart attacks are from an allergic reaction that led to Kounis Syndrome? How many of those who died are from undiagnosed and untreated Kounis Syndrome?

The VAERS system is not perfect. Adverse effects are underreported, according to the Lazarus report.

Adverse events from drugs and vaccines are common, but underreported. Although 25% of ambulatory patients experience an adverse drug event, less than 0.3% of all adverse drug events
and 1-13% of serious events are reported to the Food and Drug Administration (FDA).

Likewise, fewer than 1% of vaccine adverse events are reported.

The treatment of mild Kounis Syndrome is different from the more common coronary artery disease. Management consists of antihistamines like famotidine and corticosteroids. Severe forms are treated in the hospital. Cardiologists are aware of Allergic angina, but non-cardiologist may not be well acquainted.

Take Away Message

Someone who developed an allergic reaction to previous shots may have worse reactions to a second or the booster shots.

If you still want the jab, let your provider know if you had previous reactions to the vaccine so that they can be ready when they give you the shot. Always talk to your doctor before making decisions about the vaccine.

If you know someone who develops chest pain after vaccination, especially young, ask the doctor if it can be Kounis Syndrome. You might save their life.

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References:

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Image credit: Heart attack By Blausen Medical Communications, Inc. – see ticket for details, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=26986463.

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