A 55-year-old man suffered a prolonged heart block, syncope and cardiac arrest three weeks after being stung by a swarm of bees, report cardiologists in India.
They are now warning doctors to be aware of the possible cardiac effects of bee stings – and not just in the first few hours afterwards.
The patient, a rubber-tapper who had been walking in a forested area when the attack occurred, was admitted to hospital with facial puffiness, breathlessness and sudden tiredness in the hours after the attack.
Doctors gave the patient epinephrine, hydrocortisone, dipheneramine maleate, intravenous fluids and tetanus toxoid to treat his presenting symptoms.
The man had no history of heart problems and his blood test results were normal but doctors gave the patient aspirin, clopidogrel, and a 100 mg injection of hydrocortisone after a CT scan of his brain revealed a left basal ganglion lacunar infarct.
The man was finally discharged with a prescription of oral prednisolone, however three weeks later he returned having experienced repeated fainting episodes.
His doctors also noted that he had developed a dangerously slow heart rate of 24 bpm. He was transferred to the intensive care cardiac ward but suffered a cardiac arrest and seizure.
It was not until eight days later that the patient was fitted with a temporary pacemaker, which was eventually replaced with a permanent one, before the patient was able to go home.
Writing in the BMJ Case Reports, the doctors said they “erred” in their judgment to delay putting in a pacemaker.
“He had a cardiac arrest and a seizure, when we decided implant a temporary pacemaker. We are apologetic, but we publish this report to prevent similar errors,” the cardiologists said adding that bee stings can cause bradycardia, and need temporary pacing early if persons with bee stings do not recover within a day or two.
Doctors now believe the bee stings triggered a delayed allergic reaction to the venom in the patient’s system, causing him to develop Kounis syndrome.
It is thought the syndrome led to a coronary spasm that led to the complete heart block.
Doctors say there should be a greater awareness of the possible effects of bee stings following an attack – not just in the immediate aftermath but in the longer term too.
“It is possible that the bees became aggressive because their territory was being invaded … This is a forewarning of an increased threat of bee aggression, and hence their stings are more potentially fatal to humans.”