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Bernasconi L, Schicchi A, Pirozzolo R, Negrini V, Scaravaggi G, Lonati D, Petrolini VM, Locatelli CA. Coronary thrombosis after European adder bite in a patient on dual antiplatelet therapy: A case report. Toxicon 2022; 220:106961. [DOI: 10.1016/j.toxicon.2022.106961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/20/2022] [Accepted: 10/28/2022] [Indexed: 11/08/2022]
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Li H, Li Y, Wu X. Acute myocardial infarction with no chest pain following a Trimeresurus stejnegeri snakebite: a case report. Am J Transl Res 2022; 14:4169-4175. [PMID: 35836840 PMCID: PMC9274599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
A 74-year-old female was bitten by a Trimeresurus stejnegeri, which is an unusual but dangerous type of snakebite. After the snakebite, the patient developed oedema, pain and numbness in the injured limb, and acute myocardial infarction, but no chest pain. The patient received base treatment, including anti-venom serum, statins and wound cleaning. After treatment, the pain in the injured limb disappeared and the swelling decreased. The patient underwent a coronary angiogram the next day, and severe stenosis of the anterior descending branch of the left coronary artery was found. She was given coronary stent implantation. After surgery, she was treated with anticoagulants, and antiplatelet medication and was discharged from the hospital on the sixth day after the condition improved. This case report of myocardial infarction-related snake envenomation aims to increase the awareness that snakebites may cause AMI and therefore, multidisciplinary management particularly from emergency physicians and cardiologists may be necessary.
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Affiliation(s)
- He Li
- Department of Emergency Medicine, Yulin First People’s Hospital (The Sixth Affiliated Hospital of Guangxi Medical University)Yulin 537000, Guangxi Zhuang Autonomous Region, China
| | - Yiyi Li
- Department of Cardiology, Yulin First People’s Hospital (The Sixth Affiliated Hospital of Guangxi Medical University)Yulin 537000, Guangxi Zhuang Autonomous Region, China
| | - Xianrong Wu
- Department of Emergency Medicine, Yulin First People’s Hospital (The Sixth Affiliated Hospital of Guangxi Medical University)Yulin 537000, Guangxi Zhuang Autonomous Region, China
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Namal Rathnayaka RMMK, Nishanthi Ranathunga PEA, Kularatne SAM. Sudden Death Following Hump-Nosed Pit Viper (Hypnale hypnale) Bite. Wilderness Environ Med 2020; 32:125-127. [PMID: 33334660 DOI: 10.1016/j.wem.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/08/2020] [Accepted: 09/14/2020] [Indexed: 10/22/2022]
Affiliation(s)
- R M M K Namal Rathnayaka
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Sri Lanka; Intensive Care Unit, Teaching Hospital, Ratnapura, Sri Lanka; Postgraduate Institute of Medicine, University of Colombo, Sri Lanka
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Razok A, Shams A, Yousaf Z. Cerastes cerastes snakebite complicated by coagulopathy and cardiotoxicity with electrocardiographic changes. Toxicon 2020; 188:1-4. [PMID: 33035563 DOI: 10.1016/j.toxicon.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
Snakebites occur worldwide with varying frequency. Outcomes associated with snakebite are varied and depend on the type of snake and the general health of the patient. We report a case of snakebite by Cerastes cerastes or desert horned viper. Consumptive coagulopathy and cardiotoxicity with electrocardiographic changes complicated the clinical course of the patient. To the best of our knowledge, this is the first reported case in the state of Qatar.
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Affiliation(s)
- Almurtada Razok
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Abdullah Shams
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Zohaib Yousaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar; Dresden International University, Dresden, Germany
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Paolino G, Di Nicola MR, Pontara A, Didona D, Moliterni E, Mercuri SR, Grano M, Borgianni N, Kumar R, Pampena R. Vipera snakebite in Europe: a systematic review of a neglected disease. J Eur Acad Dermatol Venereol 2020; 34:2247-2260. [PMID: 32530549 DOI: 10.1111/jdv.16722] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/20/2020] [Indexed: 12/13/2022]
Abstract
In 2009, snakebites were included in the list of the World Health Organization (WHO) neglected diseases. Dermatological literature lacks current and up-to-date articles about snakebites and their management, despite the fact that dermatologists, especially from rural hospitals, can be called into the emergency room to consult the management of suspected snakebites. In this systematic review, we highlighted the main clinical and laboratory aspects of snakebites from Vipera spp. in Europe, by reviewing 3574 studies initially retrieved from PubMed, Embase and Cochrane CENTRAL databases. Of these, 78 were finally included in the systematic review. We found that the most involved taxon was V. berus in 63.3% and the most involved anatomic site of the bite was the upper limbs 53.1% with fang marks reported in 90.5%. The mean age of the patients was 32.9 years, and bites were slightly more common among males (58.2%). A wound washing was performed in 86.9% of cases before the hospitalization. The most frequently reported grade of envenomation was G2 (42.2%). In addition to local dermatological symptoms (extended erythema, oedema, cutaneous necrosis, hives, purpura, petechiae, acute compartment syndrome), numerous systemic symptoms have also been reported, including fatigue (14.4%), pain (75.3%), fever (49.2%), direct anaphylactoid reaction (5.3%), anxiety (60.8%), cranial nerve neurotoxicity (14.8%), dysesthesia/paraesthesia (7.9%), vomiting (33.7%), abdominal pain (23.3%), diarrhoea (15.4%), dyspnoea (6.3%), proteinuria (10.6%) and haematuria (9.3%). Secondary infections were present in 3.5% and disseminated intravascular coagulation in 3.1% of cases, and fasciotomy was performed in 4.2% cases, while an amputation in 6.9%. Only 0.9% of patients died. Antivenom was administered in 3053 cases. In conclusion, there is a pressing need for robust multi-centre randomized control trials, standardized protocol for snakebite management and antivenom administration across Europe and a National snakebite register for each European country.
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Affiliation(s)
- G Paolino
- Clinica Dermatologica, La Sapienza University of Rome, Rome, Italy.,Unit of Dermatology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - A Pontara
- Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - D Didona
- Department of Dermatology and Allergology, Philipps Medical University of Marburg, Marburg, Germany
| | - E Moliterni
- Clinica Dermatologica, La Sapienza University of Rome, Rome, Italy
| | - S R Mercuri
- Unit of Dermatology, IRCCS San Raffaele Hospital, Milan, Italy
| | - M Grano
- Via Valcenischia, Rome, Italy
| | | | - R Kumar
- Unit of Dermatology, IRCCS San Raffaele Hospital, Milan, Italy
| | - R Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Ongprakobkul C, Jaigla P, Kositanurit W, Thanprasertsuk S. Sudden cardiac arrest and cerebral thrombosis due to bites by Russell’s viper ( Daboia siamensis). TOXICOLOGY COMMUNICATIONS 2019. [DOI: 10.1080/24734306.2019.1624012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Simpson CH, Richardson WH, Swartzentruber GS, Lloyd VJ. ST Segment Elevation Myocardial Infarction Following a Crotalus horridus Envenomation. Wilderness Environ Med 2018; 29:383-387. [DOI: 10.1016/j.wem.2018.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/17/2018] [Accepted: 02/22/2018] [Indexed: 12/29/2022]
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Namal Rathnayaka RMMK, Nishanthi Ranathunga PEA, Ranaweera J, Jayasekara K, Kularatne SAM. Cardiac arrest and atrial fibrillation in a patient after hump-nosed pit viper (Hypnale hypnale) bite. Toxicon 2018; 148:33-39. [PMID: 29608921 DOI: 10.1016/j.toxicon.2018.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/09/2018] [Accepted: 03/28/2018] [Indexed: 11/19/2022]
Abstract
A 42-year-old previously healthy male patient died 16 days after a proven hump-nosed pit viper (Hypnale hypnale) envenoming due to multi-organ failure. On admission he had cardiac arrest that recovered from cardiopulmonary resuscitation then developed atrial fibrillation which was reverted to normal rhythm by application of synchronized electrical cardioversion. He also had persistent coagulopathy and thrombotic microangiopathy comprising the triad of microangiopathic haemolysis, acute kidney injury and thrombocytopenia. This is the second reported case with cardiac complications following hump-nosed pit viper bites in Sri Lanka.
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Affiliation(s)
- R M M K Namal Rathnayaka
- Intensive Care Unit, Provincial General Hospital, Ratnapura, Sri Lanka; Department of Veterinary Pathobiology, Faculty of Veterinary Medicine & Animal Science, University of Peradeniya, Sri Lanka; Postgraduate Institute of Medicine, University of Colombo (Clinical Pharmacology and Therapeutics), Sri Lanka.
| | | | | | | | - S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
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de Silva NL, Gooneratne L, Wijewickrama E. Acute myocardial infarction associated with thrombotic microangiopathy following a hump-nosed viper bite: a case report. J Med Case Rep 2017; 11:305. [PMID: 29082854 PMCID: PMC5662098 DOI: 10.1186/s13256-017-1484-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 10/07/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hump-nosed viper bite is the commonest cause of venomous snakebite in Sri Lanka. Despite initially being considered a moderately venomous snake more recent reports have revealed that it could cause significant systemic envenoming leading to coagulopathy and acute kidney injury. However, myocardial infarction was not reported except for a single case, which occurred immediately after the snakebite. CASE PRESENTATION A 50-year-old previously healthy Sri Lankan woman had a hump-nosed viper bite with no evidence of systemic envenoming during initial hospital stay. Five days later she presented with bite site cellulitis with hemorrhagic blisters, acute kidney injury, and evidence of microangiopathic hemolytic anemia and thrombocytopenia with normal coagulation studies. She was managed with supportive care that included intravenously administered antibiotics, blood transfusions, and hemodialysis; both her microangiopathic hemolytic anemia and thrombocytopenia improved without any specific intervention. On day 10 she developed: a non-ST elevation myocardial infarction complicated with acute left ventricular failure evidenced by acute shortness of breath with desaturation despite adequate ultrafiltration; new onset lateral lead T inversions in electrocardiogram; raised troponin I titer; and hypokinetic segments on echocardiogram. She was managed with low molecular weight heparin and antiplatelet drugs, which were later discontinued due to upper gastrointestinal bleeding. Her hospital stay was further complicated by hospital-acquired pneumonia and deep vein thrombosis involving her ileofemoral vein. She died on day 33 from the snakebite. CONCLUSIONS Myocardial infarction after snakebites is rarely reported. This is the first case report of a patient developing a myocardial infarction during the recovery phase of thrombotic microangiopathy following a hump-nosed viper bite. The possibility of thrombotic risk related to thrombotic microangiopathy following hump-nosed viper bite is an area that is poorly studied; it needs further attention.
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Affiliation(s)
| | - Lalindra Gooneratne
- Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Eranga Wijewickrama
- University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka. .,Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 271, Kynsey road, Colombo 08, Sri Lanka.
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Karabuva S, Lukšić B, Brizić I, Latinović Z, Leonardi A, Križaj I. Ammodytin L is the main cardiotoxic component of the Vipera ammodytes ammodytes venom. Toxicon 2017; 139:94-100. [PMID: 29030107 DOI: 10.1016/j.toxicon.2017.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/08/2017] [Accepted: 10/08/2017] [Indexed: 11/15/2022]
Abstract
Venom of the nose-horned viper (V. a. ammodytes) as also venoms of some related European viperids can induce also cardiotoxic effects in mammals. In this work we demonstrated that the protein in the V. a. ammodytes venom acting on heart is a myotoxic secreted phospholipase A2 analogue ammodytin L (AtnL). In the isolated perfused rat heart AtnL induced significant and irreversible cardiotoxicity characterized by atrioventricular (AV) blockade. This venom protein induced appearance of high levels of creatine kinase, lactate dehydrogenase, aspartate aminotransferase and troponin I in the sinus effluent of the isolated heart, indicative for myocardial damage, which is obviously the primary cause of its cardiotoxic action. Gel filtration chromatography subfractions C1 and C2 of the V. a. ammodytes venom harboured most of the venom cardiotoxicity. As we showed, just these two subfractions contained also AtnL. Subfraction C1 in the final CF concentration 11.3 μg/mL (containing 3.1 μg/mL AtnL) induced a complete cardiac arrest while subfraction C2 in the final CF concentration 6.0 μg/mL (containing 0.8 μg/mL AtnL) and the pure AtnL (1.0 μg/mL) did not. Contrary to AtnL, subfraction C1 at 11.3 μg/mL was not able to induce the AV blockade. This exposed the only other cardiotoxic subfractions-specific venom protein, a cysteine-rich secretory protein (CRISP), as an additional venom component potentially involved in modulation of the heart activity. Cardiotoxicity reported in some cases of the adder (V. berus) venom and the asp viper (V. aspis) venom poisonings may be assigned to AtnL in these venoms.
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Affiliation(s)
- Svjetlana Karabuva
- Clinical Department of Infectious Diseases, University Hospital of Split, Šoltanska 1, Split, Croatia.
| | - Boris Lukšić
- Clinical Department of Infectious Diseases, University Hospital of Split, Šoltanska 1, Split, Croatia; University of Split School of Medicine, Šoltanska 2, Split, Croatia.
| | - Ivica Brizić
- Department of Pharmacology, Mostar University School of Medicine, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina.
| | - Zorica Latinović
- Department of Molecular and Biomedical Sciences, Jožef Stefan Institute, Jamova cesta 39, Ljubljana, Slovenia; Jožef Stefan International Postgraduate School, Jamova cesta 39, Ljubljana, Slovenia.
| | - Adrijana Leonardi
- Department of Molecular and Biomedical Sciences, Jožef Stefan Institute, Jamova cesta 39, Ljubljana, Slovenia.
| | - Igor Križaj
- Department of Molecular and Biomedical Sciences, Jožef Stefan Institute, Jamova cesta 39, Ljubljana, Slovenia.
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Mechanisms Involving Myocardial Injury in Tropical Stings and Bites. Case Rep Emerg Med 2017; 2017:4960505. [PMID: 29230332 PMCID: PMC5688371 DOI: 10.1155/2017/4960505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 10/16/2017] [Indexed: 11/19/2022] Open
Abstract
It is known that a number of toxic substances produce myocardial injury by several mechanisms involving interruption of coronary blood flow due to stimulation of clotting mechanism and coronary vasospasm. Number of toxic substances may cause direct myocardial toxicity independent of coronary blood flow. Acute myocardial injury due to stings and bites is a rare entity and not well understood. Here we illustrate a case of myocardial injury due to Russell's viper envenomation.
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Kim OH, Lee JW, Kim HI, Cha K, Kim H, Lee KH, Hwang SO, Cha YS. Adverse Cardiovascular Events after a Venomous Snakebite in Korea. Yonsei Med J 2016; 57:512-7. [PMID: 26847308 PMCID: PMC4740548 DOI: 10.3349/ymj.2016.57.2.512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/20/2015] [Accepted: 07/20/2015] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Although cardiac involvement is an infrequently recognized manifestation of venomous snakebites, little is known of the adverse cardiovascular events (ACVEs) arising as a result of snakebite in Korea. Accordingly, we studied the prevalence of ACVEs associated with venomous snakebites in Korea and compared the clinical features of patients with and without ACVEs. MATERIALS AND METHODS A retrospective review was conducted on 65 consecutive venomous snakebite cases diagnosed and treated at the emergency department of Wonju Severance Christian Hospital between May 2011 and October 2014. ACVEs were defined as the occurrence of at least one of the following: 1) myocardial injury, 2) shock, 3) ventricular dysrhythmia, or 4) cardiac arrest. RESULTS Nine (13.8%) of the 65 patients had ACVEs; myocardial injury (9 patients, 13.8%) included high sensitivity troponin I (hs-TnI) elevation (7 patients, 10.8%) or electrocardiogram (ECG) determined ischemic change (2 patients, 3.1%), and shock (2 patient, 3.1%). Neither ventricular dysrhythmia nor cardiac arrest was observed. The median of elevated hs-TnI levels observed in the present study were 0.063 ng/mL (maximum: 3.000 ng/mL) and there was no mortality in the ACVEs group. Underlying cardiac diseases were more common in the ACVEs group than in the non-ACVEs group (p=0.017). Regarding complications during hospitalization, 3 patients (5.4%) in the non-ACVEs group and 3 patients (33.3%) in the ACVEs group developed bleeding (p=0.031). CONCLUSION Significant proportion of the patients with venomous snakebite is associated with occurrence of ACVEs. Patients with ACVEs had more underlying cardiac disease and bleeding complication.
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Affiliation(s)
- Oh Hyun Kim
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Joon Woo Lee
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Hyung Il Kim
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Kyoungchul Cha
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Hyun Kim
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Kang Hyun Lee
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Yong Sung Cha
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea.
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Thillainathan S, Priyangika D, Marasinghe I, Kanapathippillai K, Premawansa G. Rare cardiac sequelae of a hump-nosed viper bite. BMC Res Notes 2015; 8:437. [PMID: 26369415 PMCID: PMC4570724 DOI: 10.1186/s13104-015-1426-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 09/09/2015] [Indexed: 11/15/2022] Open
Abstract
Background The hump-nosed pit viper (Hypnale hypnale) is the commonest cause for venomous snakebites in Sri Lanka. Previously, it was thought to cause only local envenomation. However recently, several systemic effects and even mortality has been reported. Along with other snakes, such as the Indian cobra (Naja naja), the common krait (Bungarus caeruleus), the Russell’s viper (Daboia russelii) and the saw-scaled viper (Echis carinatus), the hump-nosed viper is now also considered capable of causing lethal envenomation. Unlike other snake species, the systemic manifestations occurring through the bite of a hump-nosed viper, such as acute renal failure, thrombotic microangiopathy etc are rare and unpredictable. Case presentation A 49-year-old Sri Lankan Tamil male presented with a hump-nosed viper bite, which had resulted in a cardiac arrest within half an hour of envenomation. On arrival to the Emergency Treatment Unit, he was unconscious and without spontaneous breathing. Electrocardiography monitoring revealed ST elevation in leads II, III and aVF with reciprocal changes in leads I and aVL—indicating inferior wall infarction—as well as atrial fibrillation. Glasgow Coma Scale was 7/15, which indicated severe brain injury and electroencephalogram on day 10 revealed a low amplitude pattern compatible with diffuse brain damage. Conclusion This case describes an authenticated case of myocardial infarction in a 49-year-old male following envenomation by a hump-nosed viper in Sri Lanka. This systemic effect of this viper’s bite has not previously been described in the literature. This case report is intended to increase the vigilance for myocardial infarction following hump-nosed viper envenomation.
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Gupta PN, Thomas J, Francis PK, Shylaja SV. +Ophitoxaemia and myocardial infarction--the issues during primary angioplasty: a review. BMJ Case Rep 2014; 2014:bcr-2013-201912. [PMID: 25342187 DOI: 10.1136/bcr-2013-201912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
'The Big four' are the most poisonous snakes in India, and especially in Kerala. These include the cobra, the viper, the krait and the sea snake. Most of the poisonous snakebites in India occur in Kerala. We believe there are only a few reports of myocardial infarction after snakebites and most of these are viper bites. We believe this is the second case of primary angioplasty for a snakebite. There are at least a few potential issues in performing a primary angioplasty in a snakebite case, namely (1) Is it a thrombus or a spasm? (2) Are the bleeding parameters deranged? Will the patient tolerate tirofiban and other glycoprotein (GB) 2b3a inhibitors? Will he develop dangerous bleeding due to the high dose of heparin needed? Further, would we save the patient from myocardial infarction only to lose him to renal failure, both due to the nephrotoxicity of the venom, the kidney being further damaged by the contrast media used for the angioplasty? We discuss all these issues as they crossed our mind, and hope it will help further treatment in others. We would like to review the available literature on these points and describe a recent case of ours.
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Affiliation(s)
- Prabha Nini Gupta
- Department of Cardiology, Medical College Hospital, Trivandrum, Kerala, India
| | - Jinesh Thomas
- Department of Cardiology, Medical College Hospital, Trivandrum, Kerala, India
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Geier MV, Quarcoo D, Spallek MF, Joachim R, Groneberg DA. Giftschlangenbisse — eine globale Herausforderung. ZENTRALBLATT FUR ARBEITSMEDIZIN ARBEITSSCHUTZ UND ERGONOMIE 2014. [DOI: 10.1007/bf03344195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bhatt A, Menon AA, Bhat R, Ramamoorthi K. Myocarditis along with acute ischaemic cerebellar, pontine and lacunar infarction following viper bite. BMJ Case Rep 2013; 2013:bcr-2013-200336. [PMID: 24014571 DOI: 10.1136/bcr-2013-200336] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cerebrovascular complications are rare following viper bites. A 65-year-old man presented with loss of consciousness and developed haemiparesis following a viper bite. Coagulation parameters were severely deranged. MRI showed acute ischaemic infarction on the left side in the precentral and postcentral gyrus, hemipons and cerebellum. Troponin T was elevated and transient left bundle branch block was seen. The patient had a good outcome following treatment with Anti Snake Venom and supportive therapy. Possible mechanisms of infarction are discussed.
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Affiliation(s)
- Alok Bhatt
- Kasturba Medical College, Manipal, Karnataka, India
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Acute MI in a stented patient following snake bite-possibility of stent thrombosis - a case report. Indian Heart J 2013; 65:327-30. [PMID: 23809391 DOI: 10.1016/j.ihj.2013.04.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 04/08/2013] [Accepted: 04/08/2013] [Indexed: 12/12/2022] Open
Abstract
Acute myocardial infarction following snake bite is rare with few reported cases in literature. A 60-year-old male underwent uneventful stenting to a critical stenosis in left anterior descending coronary artery in June 2012. A month later, he presented to the local hospital with history of snake bite. During admission he developed chest pain with ST-segment elevation in anterior leads consistent with stent thrombosis. He was successfully thrombolysed and his coronary angiogram 5 days later revealed patent stent with TIMI III flow and no evidence of thrombus.
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Niraj M, Jayaweera JL, Kumara IW, Tissera NW. Acute myocardial infarction following a Russell's viper bite: a case report. Int Arch Med 2013; 6:7. [PMID: 24499589 PMCID: PMC3605354 DOI: 10.1186/1755-7682-6-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 02/08/2013] [Indexed: 01/31/2023] Open
Abstract
Introduction Snake bite is a common and devastating environmental hazard, especially in rural areas of tropical countries. Acute myocardial infarction caused by snakebite has rarely been reported. To our knowledge we found only 10 cases of Myocardial infarction following a viper bite in English literature. Case presentation We report a case of inferior ST elevation myocardial infarction following a Russell’s viper bite in a 37 year old healthy Sri Lankan (South Asian) female with no past history of cardiac disease or cardiac risk factors who died 30 hours following the bite. Conclusion The course of events with respect to myocardium suggests a direct toxic effect of the venom on myocardial tissue or coronary vasoconstriction. Physicians should bear in mind the complications and devastating sequela of Myocardial infarction following Russell’s viper bite.
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Silva A, Pilapitiya S, Siribaddana S. Acute myocardial infarction following a possible direct intravenous bite of Russell's viper (Daboia russelli). BMC Res Notes 2012; 5:500. [PMID: 22971617 PMCID: PMC3490800 DOI: 10.1186/1756-0500-5-500] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 09/03/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Russell's viper (Daboia russelli) bites lead to high morbidity and mortality in South Asia. Although variety of clinical manifestations is reported in viper bite victims, myocardial ischemic events are rare. CASE PRESENTATION We report a unique case of inferior wall ST elevation myocardial infarction due to a Russell's viper bite over a vein with possible direct intravenous envenoming, in a young male with no past history or family history suggestive of ischemic cardiac disease, from Sri Lanka. In addition, the possible mechanisms of myocardial ischemia in snake bite victims are also briefly discussed. CONCLUSION Importance of the awareness of physicians on the rare, yet fatal manifestations of snake envenoming is highlighted.
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Affiliation(s)
- Anjana Silva
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Senaka Pilapitiya
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
- Institute of Research and Development, Battaramulla, Sri Lanka
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Abstract
BACKGROUND Viper bites and subsequent evolution to severe envenomations are more frequent in children. AIM The aims of this study were to describe the clinical, biological, and therapeutic characteristics of children bitten by vipers in France and to identify risk factors associated with severe envenomations. METHODS A retrospective study was conducted between 2001 and 2009 in the pediatric emergency department of a tertiary-level children hospital. Collected data were age and sex of children; day and time of admission; day, time, and circumstances of the accident; snake identification; bite location; envenomation severity; presence of fang marks; prehospital care; use of specific immunotherapy and associated treatments; length of stay; and hospital course. RESULTS Fifty-eight children were included (43 boys, 15 girls). The mean age was 7.8 ± 4.1 years. Bites were most often located on the lower extremities (77%). The classification of envenomation was: 83% low grade (absence or minor envenomation) and 17% high-grade (moderate to severe envenomations). All high-grade envenomations received specific immunotherapy (Viperfav). Being bitten on an upper extremity (P < 0.001), during the afternoon (P = 0.025), feeling violent pain (P = 0.037), and high initial glucose level (P = 0.016) were associated with a significant risk of high-grade envenomation. In the multivariate analysis, 3 factors remained significant: upper-extremity location (relative risk [RR], 60.5 [3.5-1040]; P = 0.005), immediate violent pain (RR, 21.5 [1.3-364.5]; P = 0.03), and female sex (RR, 17.5 [0.9-320.3]; P = 0.053). CONCLUSIONS A certain number of criteria seem related to more significant risk of progression to high-grade envenomation. Bites to the upper extremities should be carefully observed because of the risk of evolution to a high-grade envenomation.
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Sundaraperumal R, Mohanasundaram K, Kumarasamy S. Acute coronary syndrome following snake bite: a report of three cases from a tertiary care hospital in rural southern India. Trop Doct 2012; 42:171-3. [PMID: 22472315 DOI: 10.1258/td.2012.120032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Snake bite is a common cause of preventable death in rural India which is often due to neurological complications and coagulopathy. We report on three patients who presented with bites and later developed acute coronary syndrome during the course of their stay in hospital. Such patients have to be managed conservatively because of their coexistent coagulopathy.
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Affiliation(s)
- Ramkumar Sundaraperumal
- Department of Critical Care and Clinical Toxicology, SRMMedical College and Hospital, Chennai, Tamilnadu, India
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Senthilkumaran S, Meenakshisundaram R, Thirumalaikolundusubramanian P. Cardiac tamponade in Russell viper (Daboia russelii) bite: case report with brief review. J Emerg Med 2012; 42:288-90. [PMID: 21459541 DOI: 10.1016/j.jemermed.2010.11.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 07/06/2010] [Accepted: 11/09/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Coagulopathy after snake bite is well known; however, cardiac tamponade as a manifestation of coagulopathy is rare. OBJECTIVE To report a case of pericardial hemorrhage with cardiac tamponade after Russell viper bite. CASE REPORT A 26-year-old man developed breathlessness after being bitten by a Russell viper. The clinical and laboratory follow-up of this case confirmed the clinical diagnosis of toxin-induced disseminated intravascular coagulation. Interestingly, pericardial hemorrhage with large pericardial effusion was evident clinically as well as on electrocardiogram and echocardiogram, as an initial presentation without any other bleeding manifestations. The patient developed cardiac arrest and was revived with cardiopulmonary resuscitation. Emergency pericardiocentesis was carried out. He was given fresh frozen plasma in addition to snake antivenin along with symptomatic management. On the third day of hospitalization, the patient's clinical and laboratory profile returned to normal and he was discharged on the fifth day. CONCLUSION Pericardial hemorrhage may be due to toxin-induced myocardial damage or pericardial vessel injury coupled with coagulopathy, possibly in conjunction with vasculitis or endothelial damage. Practitioners and physicians should suspect and search for pericardial effusion in snake bite victims who develop breathlessness, and treat it vigorously in addition to antivenin therapy.
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Morsures de vipères chez l’enfant. Arch Pediatr 2011; 18:1278-83. [DOI: 10.1016/j.arcped.2011.08.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 06/23/2011] [Accepted: 08/26/2011] [Indexed: 11/18/2022]
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Karlson-Stiber C, Salmonson H, Persson H. A nationwide study of Vipera berus bites during one year-epidemiology and morbidity of 231 cases. Clin Toxicol (Phila) 2006; 44:25-30. [PMID: 16496490 DOI: 10.1080/15563650500394597] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To describe clinical course, influence of treatment, and epidemiology of Vipera berus envenomation in a defined population, and to compare the results with those of a similar, nationwide study in 1975. Design. Retrospective case review study. SETTING AND SUBJECTS Case records regarding all patients treated in Swedish hospitals during 1995 for bites by the common European adder, V. berus, were studied. A severity grading was applied. Possible dropout was fewer than 10 patients. RESULTS A total of 231 inpatients were treated for V. berus bites in Sweden in 1995. Children less than 10 years old were overrepresented and there was a slight predominance for males. Maximum severity of envenomation was none in 11%, minor in 47%, moderate in 29%, and severe in 13% of the cases. A few patients with initially minor or moderate symptoms eventually met the criteria of severe envenomation. Less commonly reported features were pulmonary edema, generalized plasma leakage, seizures, deep venous thrombosis, compartment syndrome, numbness and paraesthesia, and myocardial infarction. Treatment included antivenom in 42 patients [ovine Fab in 30 and equine F(ab')2 in 12 cases]. Systemic symptoms resolved during or shortly after the antivenom infusion. Extensive edema involving the trunk occurred in 5% of the cases in 1995, whereas 14% of the patients had extensive swelling in 1975. CONCLUSIONS Incidence and other epidemiological data were similar to those 20 years ago, whereas the clinical course was more benign. It seems reasonable to believe that this is due to the introduction of effective antivenoms.
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Gaballa M, Taher T, Brodin LA, van der Linden J, O'Reilly K, Hui W, Brass N, Cheung PK, Grip L. Images in cardiovascular medicine. Myocardial infarction as a rare consequence of a snakebite: diagnosis with novel echocardiographic tissue Doppler techniques. Circulation 2006; 112:e140-2. [PMID: 16157777 DOI: 10.1161/circulationaha.104.492942] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Salam AM, Albinali HA, Gehani AA, Al Suwaidi J. Acute myocardial infarction in a professional diver after jellyfish sting. Mayo Clin Proc 2003; 78:1557-60. [PMID: 14661686 DOI: 10.4065/78.12.1557] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
To our knowledge, acute myocardial infarction after jellyfish envenomation has not been reported previously. We describe a previously healthy 45-year-old male diver who had an acute inferior myocardial infarction with right ventricular involvement after a jellyfish sting on his left forearm while diving in the Gulf Sea. The patient had a normal controlled ascent after the incident. He had no risk factors for coronary artery disease, and cardiac catheterization revealed normal coronary arteries. Acute myocardial infarction should be considered in patients who experience chest pain or have hemodynamic compromise after jellyfish envenomation.
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Affiliation(s)
- Amar M Salam
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Sate of Qatar
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Hung DZ, Wu ML, Deng JF, Yang DY, Lin-Shiau SY. Multiple thrombotic occlusions of vessels after Russell's viper envenoming. PHARMACOLOGY & TOXICOLOGY 2002; 91:106-10. [PMID: 12427109 DOI: 10.1034/j.1600-0773.2002.910303.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Systemic bleeding due to consumption coagulopathy and thrombocytopenia due to activation of procoagulants is the leading manifestation and cause of death in Russell's viper systemic envenoming. Thrombotic occlusion of the blood vessels is rare in cases of snakebite. In this report, two adult patients with Russell's viper systemic envenoming presented multiple cerebral infarctions, digital gangrenes and ischaemic organs in addition to typical clinical manifestations of bleeding diathesis and renal involvement. Our findings in these two special cases suggest that the venom-induced coagulopathy and endothelium damage, predisposed by toxin-induced vasoconstriction, might be the possible mechanism of multiple thrombotic vascular occlusions in systemic envenoming of Formosan Russell's viper.
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Affiliation(s)
- Dong-Zong Hung
- Institute of Toxicology, National Taiwan University, Taipei, Taiwan
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Pontillo D, Capezzuto A, Castellani R. Acute generalized urticaria leading to acute myocardial infarction. Angiology 2000; 51:89-90. [PMID: 10667649 DOI: 10.1177/000331970005100115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
OBJECTIVES To assess efficacy and safety of two equine F(ab')2 antivenoms currently used to treat envenoming by European vipers. DESIGN Retrospective case review study. SETTING Case records collected by the Swedish Poison Information Centre concerning patients treated in Swedish hospitals for bites by the common European adder, Vipera berus. SUBJECTS Patients presenting with V. berus envenoming treated with antivenom (n = 30) and two groups of patients not given antivenom (n = 16 and n = 38). MAIN OUTCOME MEASURES Clinical course and time in hospital were retrospectively studied and compared in patients treated or not treated with antivenom. RESULTS There was a significantly lower incidence of extensive oedema (23 vs. 88%) and anaemia (10 vs. 50%) in the antivenom-treated group, and the hospital stay was shorter (median: 3 vs. 6 days). Antivenom treatment also resulted in prompt clinical improvement in the acute phase. Adverse effects consisting of urticaria and serum sickness occurred in 10% of the patients given antivenom. CONCLUSIONS Antivenom treatment was associated with a reduced morbidity in severe V. berus envenoming. However, the occurrence of allergic side-effects is not negligible with this type of antivenom.
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Troubles de la coagulation et thromboses induits par la morsure de serpent (bothrops lanceolatus) chez l'homme en Martinique. ACTA ACUST UNITED AC 1994. [DOI: 10.1016/s1164-6756(05)80309-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bou-Abboud CF, Kardassakis DG. Acute myocardial infarction following a gila monster (Heloderma suspectum cinctum) bite. West J Med 1988; 148:577-9. [PMID: 3176464 PMCID: PMC1026187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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