Black Widow Spider Envenomation and Cardiovascular Complications

Abstract

Envenomation (latrodectism) with black widow spider (BWS) venom can cause dysfunction in the cardiovascular system. The pathophysiology and consequences of cardiovascular effects have not been fully elucidated. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Of 364 initial results, 22 articles (20 case reports and two case series) were used with 25 patients in total. Seventeen (68%) patients had hypertension, and 16 (64%) had tachycardia. High troponin levels were found in 16 (64%) patients. Electrocardiographic changes consisted of nine (36%) patients with ST-T segment abnormalities and three (12%) patients with supraventricular tachyarrhythmias. Wall motion abnormalities were present in 11 (44%) patients, with three of the patients experiencing left ventricle global hypokinesis. A reduced ejection fraction was present in 10 (40%) patients. Only six (24%) patients received antivenom and were discharged with no further complications. In conclusion, raising awareness for cardiovascular complications could be useful as there are no pathognomonic features in imaging or electrocardiogram (ECG). The impact of antivenom on cardiovascular complications has not been prospectively studied.