Case report 387
Acute stent thrombosis and/or atrial fibrillation occurring after bee sting Fatih Kahramana, Mehmet Ozaydina, Ercan Varola, Serdar Gulera, Hatem Aria, Koray Adalia and Mustafa Karabacakb Acute stent thrombosis may result from many causes. Bee sting is a very rare cause of this situation. As bee venom activates some inflammatory and vascular events resulting in occlusion in vessels or diseases in electrical system of heart, it may cause myocardial infarction or atrial fibrillation. This problem may be temporary or fatal. Because of its pathologic effects, to be able to catch on and treat them shortly is very important. Blood Coagul Fibrinolysis 25:387–388 ß 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Case 1 A 62-year-old male patient was admitted to emergency department with squeezing chest pain radiating to left arm, which was started 1 h ago. He stated that he was stung by approximately 20 bees 2 h ago while working in the garden. Electrocardiography showed 5 mm ST elevation in V1-6 leads and reciprocal ST depressions (Fig. 1). His vital signs were stable. Blood pressure was 140/80 mmHg, heart rate was 90, and physical examination was normal. Any finding related to allergic reaction such as itching, respiratory problems, erythema or angioedema was not detected. He was a diabetic patient and a hyperlipidemic. He had a recent percutaneous coronary intervention history. He had been admitted to hospital with the diagnosis of unstable angina pectoris, and two paclitaxel-eluting stents were implanted into left anterior descending (LAD) artery 1 month ago. He has been taking acetylsalicilic acid, clopidogrel, bisoprolol and amlodipin since then regularly. He was immediately taken into angiography
Blood Coagulation and Fibrinolysis 2014, 25:387–388 Keywords: atrial fibrillation, bee sting, stent thrombosis a Department of Cardiology, Suleyman Demirel University and bDepartment of Cardiology Service, Isparta State Hospital, Isparta, Turkey
Correspondence to Dr Fatih Kahraman, Aksu Cad. Songur apt, no: 56/4, Posta kodu: 32040, Isparta, Turkey Tel: +90 544 276 46 16; fax: +90 246 218 0163; e-mail: [email protected] Received 22 August 2013 Accepted 5 November 2013
laboratory for primary percutaneous transluminal coronary angioplasty (PTCA). Complete LAD obstruction in the proximal part of stent was seen in coronary angiography (Fig. 2). Primary LAD PTCA was performed, and thrombolysis in myocardial infarction-III blood flow was supplied (Fig. 3). Tirofiban infusion was started after the procedure because of dense thrombus formation. Angina was relieved, and ST segment resolution occurred in a short time (Fig. 4). His follow-up was uneventful in service, and he was discharged without any problem. Until now, a few myocardial infarction cases occurring after bee sting have been published in the literature. However, to the best of our knowledge no stent thrombosis has been presented. Therefore, we wanted to share this interesting case here. Fig. 2
Fig. 1
ECG shows 5 mm ST elevation in V1-6 leads.
0957-5235 ß 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Total occlusion of the LAD in the proximal part is seen in angiography. LAD, left anterior descending.
DOI:10.1097/MBC.0000000000000025
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
388 Blood Coagulation and Fibrinolysis 2014, Vol 25 No 4
Fig. 3
Fig. 4
ECG after the procedure indicating ST segment resolution.
TIMI-III flow is seen after the procedure. TIMI-III, thrombolysis in myocardial infarction-III.
Case 2 A 46-year-old male patient was admitted to the emergency department with tachycardia and dizziness. He stated that he had been stung by a few bees on his back. In emergency department his vital signs were unstable. His heart rate was 140 beat per minute (bpm) and was irregular, and blood pressure was 70/40 mmHg. His ECG showed ischemic findings in inferior derivations, and rhythm was atrial fibrilation. Because of hemodynamic instability and ischemic findings, he was admitted to the coronary intensive care unit. He did not respond to electrical cardioversion, so 20 mg diltiazem was administered intravenously. Sinus rhythm was carried out after 10 min. Blood pressure
was increased up to 120/80 mmHg, and heart rate was decreased to 80 bpm. In follow-up, his cardiac enzymes were elevated. Owing to ischemic findings in ECG and laboratory results, coronary angiography (CAG) was planned. In CAG, no coronary disease was seen. The patient was discharged with a diltiazem prescription. Contents of bee venom such as dopamine, epinephrine, leukotrienes and thromboxanes can cause acute myocardial infarction or arrhythmias or temporary ST elevation because of intraarterial thrombosis, vasospasm or hypotension. Acute intervention is very important in these situations.
Acknowledgements Conflicts of interest
There are no conflicts of interest.
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Acute stent thrombosis and/or atrial fibrillation occurring after bee sting Fatih Kahramana, Mehmet Ozaydina, Ercan Varola, Serdar Gulera, Hatem Aria, Koray Adalia and Mustafa Karabacakb Acute stent thrombosis may result from many causes. Bee sting is a very rare cause of this situation. As bee venom activates some inflammatory and vascular events resulting in occlusion in vessels or diseases in electrical system of heart, it may cause myocardial infarction or atrial fibrillation. This problem may be temporary or fatal. Because of its pathologic effects, to be able to catch on and treat them shortly is very important. Blood Coagul Fibrinolysis 25:387–388 ß 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Case 1 A 62-year-old male patient was admitted to emergency department with squeezing chest pain radiating to left arm, which was started 1 h ago. He stated that he was stung by approximately 20 bees 2 h ago while working in the garden. Electrocardiography showed 5 mm ST elevation in V1-6 leads and reciprocal ST depressions (Fig. 1). His vital signs were stable. Blood pressure was 140/80 mmHg, heart rate was 90, and physical examination was normal. Any finding related to allergic reaction such as itching, respiratory problems, erythema or angioedema was not detected. He was a diabetic patient and a hyperlipidemic. He had a recent percutaneous coronary intervention history. He had been admitted to hospital with the diagnosis of unstable angina pectoris, and two paclitaxel-eluting stents were implanted into left anterior descending (LAD) artery 1 month ago. He has been taking acetylsalicilic acid, clopidogrel, bisoprolol and amlodipin since then regularly. He was immediately taken into angiography
Blood Coagulation and Fibrinolysis 2014, 25:387–388 Keywords: atrial fibrillation, bee sting, stent thrombosis a Department of Cardiology, Suleyman Demirel University and bDepartment of Cardiology Service, Isparta State Hospital, Isparta, Turkey
Correspondence to Dr Fatih Kahraman, Aksu Cad. Songur apt, no: 56/4, Posta kodu: 32040, Isparta, Turkey Tel: +90 544 276 46 16; fax: +90 246 218 0163; e-mail: [email protected] Received 22 August 2013 Accepted 5 November 2013
laboratory for primary percutaneous transluminal coronary angioplasty (PTCA). Complete LAD obstruction in the proximal part of stent was seen in coronary angiography (Fig. 2). Primary LAD PTCA was performed, and thrombolysis in myocardial infarction-III blood flow was supplied (Fig. 3). Tirofiban infusion was started after the procedure because of dense thrombus formation. Angina was relieved, and ST segment resolution occurred in a short time (Fig. 4). His follow-up was uneventful in service, and he was discharged without any problem. Until now, a few myocardial infarction cases occurring after bee sting have been published in the literature. However, to the best of our knowledge no stent thrombosis has been presented. Therefore, we wanted to share this interesting case here. Fig. 2
Fig. 1
ECG shows 5 mm ST elevation in V1-6 leads.
0957-5235 ß 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Total occlusion of the LAD in the proximal part is seen in angiography. LAD, left anterior descending.
DOI:10.1097/MBC.0000000000000025
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
388 Blood Coagulation and Fibrinolysis 2014, Vol 25 No 4
Fig. 3
Fig. 4
ECG after the procedure indicating ST segment resolution.
TIMI-III flow is seen after the procedure. TIMI-III, thrombolysis in myocardial infarction-III.
Case 2 A 46-year-old male patient was admitted to the emergency department with tachycardia and dizziness. He stated that he had been stung by a few bees on his back. In emergency department his vital signs were unstable. His heart rate was 140 beat per minute (bpm) and was irregular, and blood pressure was 70/40 mmHg. His ECG showed ischemic findings in inferior derivations, and rhythm was atrial fibrilation. Because of hemodynamic instability and ischemic findings, he was admitted to the coronary intensive care unit. He did not respond to electrical cardioversion, so 20 mg diltiazem was administered intravenously. Sinus rhythm was carried out after 10 min. Blood pressure
was increased up to 120/80 mmHg, and heart rate was decreased to 80 bpm. In follow-up, his cardiac enzymes were elevated. Owing to ischemic findings in ECG and laboratory results, coronary angiography (CAG) was planned. In CAG, no coronary disease was seen. The patient was discharged with a diltiazem prescription. Contents of bee venom such as dopamine, epinephrine, leukotrienes and thromboxanes can cause acute myocardial infarction or arrhythmias or temporary ST elevation because of intraarterial thrombosis, vasospasm or hypotension. Acute intervention is very important in these situations.
Acknowledgements Conflicts of interest
There are no conflicts of interest.
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
