A Wasp Sting and a Broken Heart James H. Diaz, MD, MPH&TM, DrPH  Wilderness & Environmental Medicine  Volume 27, Issue 2, Pages 326-329 (June 2016) DOI: 10.1016/j.wem.2015.12.002 Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 1 Left ventriculography during cardiac catheterization at systole that demonstrates apical ballooning akinesis with basal hyperkinesis. This was not the left ventriculogram during the cardiac catheterization of the case reported. Photograph by Steven Fruitsmaak (public domain). Wilderness & Environmental Medicine 2016 27, 326-329DOI: (10.1016/j.wem.2015.12.002) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 2 Traditional Japanese octopus trapping pot or takotsubo. The shape of the octopus pots resembles the characteristic systolic left ventriculogram described in cases of takotsubo or octopus pot cardiomyopathy. Source: National Library of Medicine of the National Institutes of Health (public domain). Wilderness & Environmental Medicine 2016 27, 326-329DOI: (10.1016/j.wem.2015.12.002) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 3 The lesser banded hornet, Vespa affinis, is widely distributed throughout Southeast Asia, and is responsible for the highest number of deaths after Hymenoptera stings in Sri Lanka. In addition to fatal anaphylactic shock, its stings have been followed by acute pulmonary edema, acute oliguria renal failure, and Kounis syndrome with and without takotsubo or octopus pot cardiomyopathy. This image was not the implicated Hymenoptera species in the case reported. Public domain image. Wilderness & Environmental Medicine 2016 27, 326-329DOI: (10.1016/j.wem.2015.12.002) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 4 The European hornet, Vespa crabro, is the largest hornet in Europe and the only true hornet species in North America, where it is also known as the European hornet. The European hornet was introduced into North America from Europe in the mid-19th century and is now widely distributed throughout North America and some northern areas of Central America. Hornets may be distinguished from yellow jackets and all other wasps by their larger heads and thicker waists and abdomens. Although this image was not the implicated Hymenoptera species in the case reported, this species could indeed have been responsible for the Hymenoptera venom allergic responses described in the case report. Despite its resemblance in coloration, the European hornet is not a yellow jacket, which is a yellow and black-striped wasp species that lives on the ground or underground and not in aerial nests. Another common source of confusion between wasps and hornets in the United States is the frequent use of the common name, bald or white-faced hornet, for the black and white-striped wasp, Dolichovespula maculata (order Hymenoptera, family Vespidae), which is another wasp species related to yellow jackets. Like European hornets, the bald-faced hornet also builds globular, hanging paper nests in trees throughout the United States. A more appropriate, alternative common name for the bald-faced hornet is black jacket. All Hymenoptera stings by bees, wasps, or hornets have the potential to cause anaphylaxis and Kounis syndrome with or without takotsubo or octopus pot cardiomyopathy. Source: Wikipedia (public domain). Wilderness & Environmental Medicine 2016 27, 326-329DOI: (10.1016/j.wem.2015.12.002) Copyright © 2016 Wilderness Medical Society Terms and Conditions