Cardiovascular manifestations in mast cell activation disease: key insights for cardiologists and angiologists.

This review describes mast cell activation disease (MCAD), including mast cell activation syndrome (MCAS), as a common, genetically driven disorder in which mast cells are overly reactive and/or abnormal. These cells release large amounts of mediators (like histamine, prostaglandins, leukotrienes, tryptase, and many others) that can affect nearly every organ, including the heart and blood vessels. The authors emphasize that cardiovascular manifestations—such as episodes of rapid heart rate, blood pressure swings, chest pain with normal coronaries, flushing, fainting or presyncope, arrhythmias, edema, and symptoms mimicking allergic or anaphylactic reactions—are frequent but often missed. With an estimated prevalence up to 17%, cardiologists and vascular specialists are likely to see many patients whose "cardiac" complaints are actually driven or worsened by mast cell mediator release. The paper calls for greater awareness of MCAD in cardiology practice, outlines the pathophysiology linking mast cell mediators to vascular tone, endothelial dysfunction, coronary spasm, and autonomic symptoms, and stresses the need to recognize MCAD as a possible underlying cause when standard cardiac workup is unrevealing. It also highlights that appropriate diagnosis and mediator‑targeted treatment (e.g., H1/H2 blockers, mast cell stabilizers, mediator synthesis inhibitors) can significantly improve cardiovascular symptoms in affected patients.