Anaphylaxis-induced acute ST-segment elevation myocardial ischemia treated with primary percutaneous coronary...

Acute coronary syndromes have been described as potential complications of any type of anaphylactic reaction. The real pathogenic mechanism inducing acute myocardial ischemia in the setting of anaphylaxis is not yet completely understood. Some pathogenic mechanisms, like coronary vasospasm, plaque activation and systemic hypotension, have been suggested. The hypothesis of a central role of mast cell and inflammatory cell activation and release of potent vasoactive mediators, inducing the mechanisms mentioned above, is the mainstay of so-called "cardiac anaphylaxis". We report two cases of anaphylaxis-induced acute ST-segment elevation myocardial ischemia which occurred during coronary angiography. The first one was probably related to contrast media contact, the second one to latex glove contact. Both of them were treated with percutaneous coronary intervention that immediately resolved the myocardial ischemia.