A Rare Case of Mad Honey Disease: A Reversible Cause of Complete Heart Block

Abstract This case describes a patient with hypotension, bradycardia, and third-degree atrioventricular block following ingestion of grayanotoxin-containing Pieris species, or Lily of the Valley bush. Although unlikely in metropolitan environments, physicians should be aware of the possibility of grayanotoxin ingestion when confronted with new-onset heart block even in nonendemic areas. (Level of Difficulty: Beginner.)