Acute coronary syndrome from scombroid poisoning: A narrative review of case reports

Background: Scombroid syndrome constitutes a toxic illness caused by ingestion of improperly stored fish, usually contaminated by Gram-negative bacteria producing histamine and other toxins. Scombroid currently accounts for approximately 5% of food toxicities in the United States. Though cardiovascular complications are infrequent, some patients experienced acute coronary syndrome (ACS) on admission to hospital. This article focuses on the main pathophysiology, clinical features, therapy, and outcomes in scombroid-related ACS. Methods: Starting from the consolidated knowledge on histaminergic syndromes, we performed a literature search for studies describing patient series and single cases presenting at emergency department with scombroid toxicity complicated by myocardial ischemia. Results: After a pathophysiological overview on histaminergic syndromes, we carefully analyzed a dataset of 19 patients from 13 studies, published from 1997 to December 2020. Electrocardiographic, echocardiographic, angiographic features, clinical course, hospital complications, and therapeutic approach were described. Shared and differential aspects of scombroid ACS with typical atherosclerotic ischemia, Kounis, MINOCA and Takotsubo syndromes are also discussed. Conclusion: An ischemic heart scombroid syndrome may occur in some patients after the eating of improperly stored fish food. Currently available studies indicate this as a benign condition, except for patients with history of coronary artery disease, previous ACS, or anaphylaxis. Of clinical concern, there is a potential of hemodynamic failure in the acute stage, even in apparently healthy people.