Heart block: neither sweet nor bitter/Kalp blogu: ne tatli ne de aci.
The mad honey is widely used as an alternative therapy for the treatment of gastrointestinal diseases such as gastritis, peptic ulcer and the reduction in the coronary artery disease (CAD) risk in Black Sea region of Turkey (1). However, mad honey produced from the nectar of some rhododendron species may be poisonous. The cause of the intoxication is the grayanotoxin which has toxic effects on sodium channels (2) and induces increased parasympathetic tone that causes life-threatening bradycardia, hypotension, and altered mental status (3). Complete heart blocks may occur in some patients. However, there was no report regarding long lasting atrioventricular (AV) block and permanent pacemaker implantation.
A 55-year-old female without any cardiovascular disease history and drug use was admitted to our emergency department with complete AV block and symptoms of nausea, dizziness and syncope. She has been taking average 50 mL/day of honey because of gastric pain for a week and she took last dose 2 h ago. Her heart rate was 39 bpm and blood pressure was 70/40 mmHg. Electrocardiogram (ECG) revealed complete AV block (Fig. 1A). Since the AV block and symptoms of the patient did not resolve with intravenous administration of 3 mg atropine sulfate, a temporary transjugular pacemaker was implanted. In addition, intravenous sodium chloride (100 mL/h) was infused. Her symptoms and hemodynamic status resolved over the next 6 h. However, no resolution occurred on ECG. Her transthoracic echocardiography showed no abnormal findings. She was hospitalized for a week, however complete AV block did not resolve overtime. Because of the persistent AV block, coronary angiography performed in order to rule out CAD and revealed normal coronary arteries. Therefore, permanent pacemaker was implanted to the patient (Fig. IB) and she was discharged uneventfully from the hospital.
[FIGURE 1 OMITTED]
(1.) Gunduz A, Turedi S, Uzun H, Topbas M. Mad honey poisoning. Am J Emerg Med 2006; 24: 595-8.
(2.) 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: 9464-71.
(3.) Ergun K, Tufekcioglu 0, Aras D, Korkmaz S, Pehlivan S. A rare cause of atrioventricular block: Mad Honey intoxication. Int J Cardiol 2005; 99:347-8.
Ugur Canpolat, Asena Gokcay Canpolat *, Kudret Aytemir
From Departments of Cardiology and * Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara-Turkey
Address for Correspondence/Yazisma Adresi: Dr. Ugur Canpolat Hacettepe Universitesi Tip Fakultesi, Kardiyoloji Anabilim Dali, 06100 Sihhiye, Ankara-Turkiye
Phone: +90 312 305 17 80 Fax: +90 312 305 41 37
Available Online Date/Cevrimici Yayin Tarihi: 18.09.2012
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|Title Annotation:||Letters to the Editors/Editore Mektuplar|
|Author:||Canpolat, Ugur; Canpolat, Asena Gokcay; Aytemir, Kudret|
|Publication:||The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi)|
|Article Type:||Letter to the editor|
|Date:||Dec 1, 2012|
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