Numerous bee stings may cause serious heart problems.

Doctors writing in the journal BMJ Case Reports describe the case of a healthy 55-year-old man in India who developed serious heart problems several weeks after being attacked by a swarm of bees.

While walking in a forest, he suffered more than 50 stings, and he was admitted to hospital with facial puffiness, breathlessness and sudden tiredness.

He had no history of and heart tests were normal. After initial treatment, his condition improved and he was discharged with anti-inflammatory medication.

But around three weeks later, he was back in hospital after developing a dangerously slow heart rate, repeated fainting, and suffering a. He almost died.

The doctors managed to save his life by inserting a temporary pacemaker, which was later replaced with a permanent pacemaker. His condition improved and he was eventually discharged home.

The doctors suspect the man had developed Kounis syndrome (a group of acute coronary events) triggered by a delayed allergic reaction to the massive amount of bee venom in his system.

Another possible reason, they say, could have been that the bees had consumed the nectar of a rhododendron flower, which contains ‘grayanotoxin’ (a natural sodium channel blocker that can slow the heart).

The cardiac effects of have been previously reported. But this case is of particular importance, explain the authors, “because earlier accounts of massive bee stings have not reported significant bradycardia. Hence, we were unaware of this complication, and hesitated to implant a temporary pacemaker.”

This report highlights the need to consider heart complications in patients with multiple bee stings, and the need for urgent action in order to prevent death, they conclude.

Case report: Possible complication of bee stings and a review of the cardiac effects of bee stings http://casereports.bmj.com/content/2016/bcr-2016-213974

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