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Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Kounis Syndrome from Multiple Bee Stings

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Bee stings are common afflictions outdoors. The common dreaded complication from a single bee, yellowjacket or wasp sting is a severe allergic reaction. Stings from multiple bees at the same time pose another group of problems, related to the volume and toxicity of venom injected into the victim. Persons who are stung by multiple bees can rapidly become quite ill.

Dimitrios Mytas and colleagues published a letter to the editor entitled "Acute anterior myocardial infarction after multiple bee stings. A case of Kounis syndrome" in the International Journal of Cardiology volume 134, pages e129 to e131, 2009. An "anterior myocardial infarction" is a heart attack that affects the anterior (front-oriented) portion of the heart muscle. In this publication, they described the case of a 58-year-old man with no prior history of heart disease or cardiovascular risk factors who was stung several times at the same time on the head and neck by honeybees while outdoors working. He became dizzy and suffered an unspecified type of difficulty breathing, but remained awake. He was taken to the hospital, where he was noted to have a red itchy rash on his face, neck and chest. While in the emergency department, he began to feel unwell with sweating, grew pale and complained of chest pain that traveled into both arms. He grew nauseated and vomited. An electrocardiogram was obtained, which was diagnostic for an acute heart attack. He was ultimately taken to the cardiac catheterization suite, where he had a stent placed in one of his coronary arteries. On followup months later, he suffered from residual (congestive) heart failure.

This event was felt to represent Kounis syndrome, which is the concurrence of an acute coronary syndrome with an allergic or hypersensitivity reaction. It can occur with no pre-existing coronary artery disease (e.g., with normal coronary arteries) or with existing, perhaps unrecognized, coronary artery disease, as appears to have been the case with this unfortunate victim.

Anyone who suffers a bee sting or any other event that may precipitate an allergic reaction (such as ant, wasp, yellowjacket or jellyfish sting; exposure to grasses, pollen, poison oak/ivy/sumac; eating shellfish, nuts; snake venom poisoning) and complains of chest pain that might be indicative of a heart attack should seek medical attention immediately.
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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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