Bradycardia, rare extreme QT prolongation and Giant inverted T waves following Grayanotoxin (mad honey) intoxication: A short communication and literature review.

Grayanotoxin poisoning, commonly known as "mad honey" intoxication, is a rare but potentially life- threatening condition primarily affecting the cardiovascular system. It is characterized by bradycardia, hypotension, and, in rare cases, extreme QT interval prolongation, which predisposes patients to malignant arrhythmias. We report a 62-year-old male with no prior cardiac history who developed dizziness, nausea, and cold sweats 30 min after ingesting a tablespoon of mad honey. On admission, he exhibited sinus bradycardia, hypotension (70/40 mmHg), and marked QTc prolongation with giant inverted T waves on electrocardiogram. Laboratory and echocardiographic evaluations were unremarkable. The patient was managed with intravenous hydration and magnesium sulfate, resulting in rapid clinical and electrocardiographic recovery within 24 h. Grayanotoxins exert their toxic effects by modulating voltage-gated sodium channels, leading to sustained depolarization and impaired cardiac conduction. While bradycardia and hypotension are well-documented manifestations, extreme QT prolongation remains a rare but critical complication due to its association with ventricular arrhythmias such as torsades de pointes. This case underscores the importance of vigilant cardiac monitoring and electrolyte management in mad honey poisoning. Early recognition and appropriate supportive treatment can prevent fatal outcomes. Mad honey intoxication should be considered in patients presenting with unexplained bradycardia and hypotension, especially in endemic regions. Extreme QT prolongation, although rare, is a significant electrophysiological disturbance that necessitates prompt intervention to mitigate arrhythmic risk.