Anaphylactic Cardiac Arrest in a Parturient

To the Editor.— I have read the report by Baraka and Sfeir entitled "Anaphylactic Cardiac Arrest in a Parturient: Response of the Newborn" (1980;243:1745). Aside from the fact that apparently the fetus was not involved in the anaphylactic reaction, the case is particularly interesting because, in my opinion, it represents additional evidence that the heart is a target organ in systemic immediate hypersensitivity reactions. The patient experienced tachycardia and "cardiac arrest," presumably caused by ventricular fibrillation. Both of these are pathognomonic signs of direct cardiac involvement in the anaphylactic reaction, as demonstrated in the laboratory by us^1,2 and others.³

Antigen reacts with antibodies bound to cardiac mast cells, and this elicits the intracardiac release of mediators such as histamine, prostaglandins, and slow-reacting substance of anaphylaxis, all of which—either alone or in combination with reflexly released catecholamines—cause severe cardiac dysfunction. Several clinical reports, some published in JAMA (1959;170:1628; 1970;211:627)