HEART DAMAGE FOLLOWING ADDER BITE IN ENGLAND

Acute myocardial infarction with no chest pain following a Trimeresurus stejnegeri snakebite: a case report

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.

Saw-scaled viper envenoming complicated with acute myocardial infarction

The saw-scaled viper (Echis carinatus) is considered to be a venomous snake which is especially seen in Northern Sri Lanka. Systemic manifestations are rare and reported complications include coagulopathy and renal impairment. The cardiac toxicity following snakebites is rare and cardiac involvement following the saw-scaled viper bites is extremely rare. Here, we describe a patient with acute myocardial infarction following systemic envenoming by saw-scaled viper in Northern Sri Lanka, which was successfully managed per ward protocol following national guidelines.

Acute Coronary Syndrome From Green Snake Envenomation

BACKGROUND

Snake bite is a grossly underreported public health issue in subtropical, tropical suburban, and rural areas of Africa and South Asia. In literature, ophitoxemia (snake bite envenomation) as a cause of acute coronary syndrome (ACS) is limited to very few case reports. Viper envenomation is the most common cause of ACS among snake bites. We report the first case of unstable angina caused by Colubridae snake bite (Ahaetullanasuta, commonly called green snakes) in a young man without comorbidities.

CASE REPORT

A young healthy man had a green snake bite that was camouflaged in the green fodder. He was managed elsewhere with anti-snake serum. He developed acute chest pain and breathlessness on day 3 of his treatment. Electrocardiogram (ECG) showed biphasic T wave inversions suggestive of type A Wellens pattern in the anterior chest leads (V1-V4). He was treated for ACS medically outside and was referred to our institute for further management on the following day. ECG and cardiac enzymes were normal. The echocardiogram showed no regional wall motion abnormality. Computed tomography coronary angiography showed normal epicardial coronaries. He was discharged in stable condition and asymptomatic at 2 months follow-up. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ACS after a snake bite is not limited to venomous snakes. The diagnosis should be considered promptly even with a nonvenomous snake bite, especially in those with typical symptoms and ECG changes. The time interval between snake bite and development of ACS can be long and warrants prolonged medical supervision.

Fatal Rattlesnake Envenomation in Northernmost Brazilian Amazon: A Case Report and Literature Overview

Snakebite envenomations are classified as Category A Neglected Tropical Diseases by the World Health Organization. In Brazil, 405 snake species are distributed among 11 families, with the genera Bothrops and Crotalus being the most studied and main responsible for severe and lethal envenomations. In the country, Crotalus genus (i.e., rattlesnakes) is represented by Crotalus durissus species, showing seven different subspecies distributed along the country, including Crotalus durissus ruruima, which inhabits Roraima, the Brazilian nothermost state from Amazon forest. Here, we report a fatal case of a severe envenomation following a rattlesnake bite. The patient presented classic crotalic neurological signs and symptoms such as ptosis, drooling of saliva, sluggishness, macroscopic hematuria, and oliguria, which evolved to acute kidney failure (AKF) and hemodynamic instability. Although the patient was treated with the specific antivenom therapy, the severe envenomation resulted in three cardiac arrests and death of the victim in less than 38 h. This study discusses the causes of the patient death, the features of rattlesnake venom-induced AKF, and shows evidences that the Brazilian crotalic antivenom should be improved to treat rattlesnake envenomations caused by C. d. ruruima venom in Roraima state.

+Ophitoxaemia and myocardial infarction--the issues during primary angioplasty: a review

'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.

Acute myocardial infarction following a Russell's viper bite: a case report

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.

Incidence, pathology, and treatment of adder (Vipera berus L.) bites in man

A review of published reports on the incidence, pathology, and treatment of adder (Vipera berus) bites in man in the United Kingdom and Europe produced numerous case studies but little information about the impact od adders as a threat to public health. Adder bites in man are not uncommon (at least 44/year and probably more than 90/year in the United Kingdom) and, although they have been recorded for every month of the year between February and October, envenoming is most likely to occur during June, July, and August. Most adder bites are on the hand (51.6%) or foot (38.2%). The effects of adder bite envenoming are now know. Effective treatment protocols can reduce both the length of time victims spend in hospital and the morbidity in the affected areas: they have resulted in a decline in the death rate over the last 30 years, so that deaths are now rare.

Adder (Vipera berus) bites: a case report and review of the management for emergency medical personnel

Few doctors working in the accident and emergency (A&E) department will have had experience in the management of adder (Vipera Berus) bites. While such events are uncommon, and rarely fatal, prompt correct management undoubtedly helps in reducing mortality and morbidity. Various isolated case reports (Watson & Harland, 1977; Gerard & Pugh, 1982; Jones & Clegg, 1985) and larger reviews (Reid, 1976; Pesson & Irestedt 1981; Hawley, 1988, 1990) have appeared in non A&E related journals. Following our own recent experience we felt it timely to report our case and review the management.

Acute myocardial infarction and cerebrovascular accident in a young girl after a viper bite

A 17-year-old girl developed an acute myocardial infarction immediately after being bitten by a viper and four days later she had a cerebrovascular accident. The close clinical and laboratory follow-up of this case suggested that myocardial damage could be attributed to a direct cardiotoxic effect of the venom, while the brain injury that subsequently appeared was probably the result of a disseminated intravascular coagulopathy, possibly in conjunction with vasculitis.

Adder bites in Britain

Ninety-five cases of adder bite that have occurred in Britain over the past 100 years are reviewed. Most bites occurred in men who foolishly picked up the adder. Three-quarters of the victims reached hospital within two hours of the bite. When venom is injected the early symptoms include local swelling and discoloration, vomiting, diarrhoea, and early collapse, which often resolves spontaneously. In severe poisoning persistent or recurrent shock is the main feature. Children recover quickly but adults may take weeks or months to recover, during which there may be considerable disability in the bitten limb. Deaths are rare: only 14 deaths from poisoning were recorded in the past 100 years. In England and Wales only one death from adder bite was recorded in 1950-72, but there were 61 deaths from bee or wasp stings. In most cases simple symptomatic treatment is enough, but all patients should be carefully monitored. With persistent or recurrent shock Zagreb antivenom is indicated; and it should also be considered in adults seen within two hours of the bite to minimise morbidity from local effects.

Abnormal electrodiogram after adder bite

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