Allergic myocardial infarction

In the literature there are very few well-documented cases of myocardial ischemia with pathomechanism accompanying allergic reaction. It is defined as Kounis syndrome, i.e. angina pectoris or infarction with allergic etiology. It is suggested, that few few cases of myocardial ischemia after a Hymenoptera sting reported thus far represent only a minute percentage of the total number of allergic reactions which occur in the circulatory system. It is difficult to make a credible decision whether allergic mechanisms are responsible for a greater number of deaths than we suspect. In the light of the literature, this review deals with current views regarding pathomechanisms of myocardial ischemia in the course of anaphylactic reaction and presents the clinical manifestation of myocardial ischemia with an allergic background, pointing out that allergic reactions involving cardiac muscle are not limited to the development of ischemia. The term organ anaphylaxis, in relation to the heart, also comprises rhythm and contractility disturbances which are present after exposure to the allergen. At the same time, the authors touch upon therapeutic aspects of immunotherapy in patients with significant cardiovascular risk and draw attention to the possibility of an alternative treatment for patients with allergic history, not only during desensitization but also for long- -term outpatient treatment. (Cardiol J 2008; 15: 220-225