The honey man--second degree heart block after honey intoxication

In October 2007, a 70-year-old Turkish patient presented to the emergency department of a Viennese state hospital with syncope. The electrocardiogram showed a second degree heart block type Wenckebach with intermittent 2:1 conduction and preterminal negative T waves. There was no biochemical evidence of an acute ischemic cardiac event or any electrolyte imbalance. A coronary angiogram showed no evidence for coronary artery disease. During the first day of hospital admission, a jar of home made honey from the Black Sea region of Turkey is brought to the hospital by relatives of the patient. A commonly used household remedy in the eastern Black Sea region of Turkey, "bitter honey" or "mad honey" contains grayanotoxin from the nectar of Rhododendron luteum and Rhododendron ponticum. This is the first documented case of honey poisoning in the European Union where structural and ischemic causes have been excluded as possible reasons for the temporary AV-block. This case serves as a poignant reminder that physicians must demonstrate awareness of the cultural, social, and in this case toxicological, particularities of patients within immigrant populations.