CMA1 and myocardial infarction: Myocardial infarction following wasp stings [74, 75] is caused by either hypotension due to shock or coronary vasoconstriction, which is induced by the released chemical mediators (histamine, chymase, tryptase, cathepsin D, leukotrienes, thromboxane and platelet activating factor) [22] and treatment with epinephrin.