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Sweet Heart Block

2008; Lippincott Williams & Wilkins; Volume: 118; Issue: 3 Linguagem: Inglês

10.1161/circulationaha.108.766071

1524-4539

Kathrin Eller, Kathrin Hochegger, Ivan Tancevski, Christoph Pechlaner, Josef R. Patsch,

Antibiotics Pharmacokinetics and Efficacy

HomeCirculationVol. 118, No. 3Sweet Heart Block Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUBSweet Heart Block Philipp Eller, MD, Kathrin Hochegger, MD, Ivan Tancevski, MD, Christoph Pechlaner, MD and Josef R. Patsch, MD Philipp EllerPhilipp Eller From the Department of Internal Medicine, Innsbruck Medical University, Innsbruck, Austria. , Kathrin HocheggerKathrin Hochegger From the Department of Internal Medicine, Innsbruck Medical University, Innsbruck, Austria. , Ivan TancevskiIvan Tancevski From the Department of Internal Medicine, Innsbruck Medical University, Innsbruck, Austria. , Christoph PechlanerChristoph Pechlaner From the Department of Internal Medicine, Innsbruck Medical University, Innsbruck, Austria. and Josef R. PatschJosef R. Patsch From the Department of Internal Medicine, Innsbruck Medical University, Innsbruck, Austria. Originally published15 Jul 2008https://doi.org/10.1161/CIRCULATIONAHA.108.766071Circulation. 2008;118:319A 56-year-old man of Turkish descent presented with severe bradycardia (37 bpm) and hypotension (65/35 mm Hg) in the emergency room. A liver transplantation had been performed 8 months before because of cirrhosis due to chronic hepatitis B. The patient was on a permanent regimen of tacrolimus, mycophenolate mofetil, lamivudine, and adefovir dipivoxil. On the day of admission, he had eaten several rolls filled with honey and honeycombs brought into Austria by a friend from Turkey. One hour after ingesting the honey, the patient started feeling ill and within 2 hours developed anginal pain, nausea, and cold sweat. On arrival at our hospital, the patient was somnolent and vomited large amounts of yellowish gastric juice. The ECG revealed complete atrioventricular block with idioventricular escape rhythm (Figure), which disappeared promptly after intravenous injection of 0.5 mg atropine. Another dose of atropine was needed after 45 minutes to keep the patient's heart rate and blood pressure within physiological ranges. Download figureDownload PowerPointFigure. ECG showing a complete atrioventricular block with an idioventricular escape rhythm of 37 bpm in a patient with honey poisoning.Food poisoning associated with grayanotoxin-contaminated honey was documented as early as 401 BC, when Xenophon described in his Anabasis the expedition of Greek troops traveling through today's Turkey into the territory of Artaxerxes II.1 Such food poisonings have been typical in habitats of Rhododendron ponticum (Data Supplement Figure) on the Anatolian Plateau and of Rhododendron occidentale, macrophyllum, and albiflorum, which are found, for instance, between Oregon and Southern California.2–3 The nectar of these plants contains grayanotoxin, which selectively binds to voltage-dependant sodium channels in their open state, thus leading to hyperpolarization of the activation potential and, as a result, to bradycardia and hypotension.4 There is no need for electrical pacing, as bradycardia and atrioventricular block in honey poisoning are responsive to the antidote atropine.Grayanotoxin intoxication should be included, not only in Turkey and California, in the differential diagnosis of bradycardia and heart block when occurring after ingestion of honey.The online-only Data Supplement, which contains a figure, is available with this article at http://circ.ahajournals.org/cgi/content/full/118/3/319/DC1.DisclosuresNone.FootnotesCorrespondence to Philipp Eller, Department of Internal Medicine, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria. E-mail [email protected]References1 Lampe KF. Rhododendrons, mountain laurel, and mad honey. JAMA. 1988; 259: 2009.CrossrefMedlineGoogle Scholar2 Biberoglu S, Biberoglu K, Komsuoglu B. Mad honey. JAMA. 1988; 259: 1943.Google Scholar3 Yavuz H, Ozel A, Akkus I, Erkul I. Honey poisoning in Turkey. Lancet. 1991; 337: 789–790.Google Scholar4 Maejima H, Kinoshita E, Seyama I, Yamaoka K. Distinct sites regulating grayanotoxin binding and unbinding to D4S6 of Na(v)1.4 sodium channel as revealed by improved estimation of toxin sensitivity. J Biol Chem. 2003; 278: 9464–9471.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By (2016) Ericaceae Meyler's Side Effects of Drugs, 10.1016/B978-0-444-53717-1.00697-1, (93-96), . Erenler A (2015) Cardiac Effects of Mad Honey Poisoning and Its Management in Emergency Department: A Review from Turkey, Cardiovascular Toxicology, 10.1007/s12012-015-9310-6, 16:1, (1-4), Online publication date: 1-Jan-2016. Aronson J (2014) Plant Poisons and Traditional Medicines Manson's Tropical Infectious Diseases, 10.1016/B978-0-7020-5101-2.00077-7, (1128-1150.e6), . Popescu R and Kopp B (2013) The genus Rhododendron: An ethnopharmacological and toxicological review, Journal of Ethnopharmacology, 10.1016/j.jep.2013.02.022, 147:1, (42-62), Online publication date: 1-May-2013. Chan K, Zhang H and Lin Z (2011) Treatments used in complementary and alternative medicine A worldwide yearly survey of new data in adverse drug reactions, 10.1016/B978-0-444-53741-6.00048-9, (989-1007), . Bostan M, Bostan H, Kaya A, Bilir O, Satiroglu O, Kazdal H, Karadag Z and Bozkurt E (2009) Clinical Events in Mad Honey Poisoning: A Single Centre Experience, Bulletin of Environmental Contamination and Toxicology, 10.1007/s00128-009-9906-2, 84:1, (19-22), Online publication date: 1-Jan-2010. Eller P and Hochegger K (2010) Honey intoxication and the Bezold–Jarisch reflex, International Journal of Cardiology, 10.1016/j.ijcard.2008.12.206, 144:2, (251), Online publication date: 1-Oct-2010. Okuyan E, Uslu A and Ozan Levent M (2010) Cardiac effects of "mad honey": a case series, Clinical Toxicology, 10.3109/15563650.2010.497150, 48:6, (528-532), Online publication date: 1-Jul-2010. ÖSKEN A, YAYLACI S, AYDIN E and ÇAM N (2021) Deli Bal Zehirlenmesi Hastalarında Elektrokardiyografi Analizi, Sakarya Medical Journal, 10.31832/smj.932847 July 15, 2008Vol 118, Issue 3 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.108.766071PMID: 18625907 Originally publishedJuly 15, 2008 PDF download Advertisement SubjectsArrhythmiasDiet and NutritionElectrocardiology (ECG)