An unusual case of inferior acute myocardial infarction associated with advanced second grade atrio-ventricular block secondary to scombroid - Fish poisoning.

Abstract

Background: Scombroid syndrome (histamine fish poisoning) includes symptoms and signs caused by biogenic amines, mainly due to histamine-containing food. Methods and results: In this report, we describe a 56 year old female who presented in the clinic with symptoms of scombroid syndrome after the ingestion of tuna fish, then gradually developed cardiovascular shock and inferior ST elevation myocardial infarction (STEMI) associated with advanced second grade atrio-ventricular block at the electrocardiogram (ECG) followed by respiratory arrest. Originally, the patient was treated with intravenous fluid infusion, steroids, ranitidine and chlorpheniramine. Following her cardiovascular shock and respiratory arrest, orotracheal intubation was performed and mechanical ventilation was started immediately. The patient was treated with dobutamine and fluid infusion, which has improved her hemodynamic conditions. Emergency cardiac catheterization was performed one hour after the onset of symptoms and coronary angiography did not show a significant coronary artery disease. The clinical picture has improved during the next days, with complete normalization of the ECG. Conclusion: Severe symptoms, including myocardial infarction. may occur in cases of scombroid syndrome. © 2013 Versita Warsaw and Springer-Verlag Berlin Heidelberg.