RT Journal Article SR Electronic T1 Possible complication of bee stings and a review of the cardiac effects of bee stings JF BMJ Case Reports FD BMJ Publishing Group Ltd SP bcr2015213974 DO 10.1136/bcr-2015-213974 VO 2016 A1 Gupta, Prabha Nini A1 Kumar, B Krishna A1 Velappan, Praveen A1 Sudheer, M D YR 2016 UL http://casereports.bmj.com/content/2016/bcr-2015-213974.abstract AB We report the case of a patient who, ∼3 weeks after multiple bee stings, developed a prolonged heart block, syncope and cardiac arrest. This required a temporary pacemaker to be implanted, which was later replaced with a permanent pacemaker. An ECG taken following surgery for a fractured humerus 6 years earlier was reportedly normal. The patient had been a rubber tapper who walked ∼1.5 km/day, but after the bee attack he was no longer able to walk or get up from the bed without experiencing syncope. We presume that the bee venom caused these signs, as well as the resulting heart block, which persisted long after the bee sting had subsided. Since his coronary angiogram was normal we believe he had a Kounis type involvement of the cardiovascular system, namely profound coronary spasm that caused complete heart block that did not recover. Another probable reason for the complete heart block could have been that the bees had consumed the pollen of a rhododendron flower, causing ‘grayanotoxin’ poisoning and severe heart block. The other effects of bee sting are discussed briefly.