Mistreated fish products ingestion can lead to a histaminergic illness known as scombroid syndrome. The disease usually causes cutaneous rash, gastrointestinal, breathing disorders, hypotension with further histamine-related symptoms. Although cardiac complications are infrequent, some patients experienced chest pain consistent with an acute coronary syndrome on admission to hospital. The pathomechanism seems related to a transient coronary artery vasospasm. We performed a literature search for all cases published in the literature from 1997 to 2022 with suspected ischemic heart scombroid syndrome. Overall, 18 studies describing 25 patients were recognized and the main pathophysiological, clinical, diagnostic, therapeutic and prognostic features are discussed. A simplified diagnostic flowchart has also been proposed. Even though this syndrome can lead to hemodynamic instability in the acute phase, also in the young, prognosis is rather good.