Cardiac MRI-Proven Myocarditis Mimicking ST-Elevation Myocardial Infarction after a Cobra Bite

Abstract

Cardiac complications following snake envenomation occur infrequently. Myocarditis, as a consequence of the toxic effect of the snake venom, is rare, and only a few cases have been reported. We present a case of an 84-year-old man who was envenomed by a cobra. In addition to respiratory failure due to neurotoxicity of the venom, cardiac abnormalities including elevated cardiac markers and abnormal electrocardiogram were found. The findings on cardiac magnetic resonance imaging confirmed the diagnosis of acute myocarditis. The patient spontaneously recovered without any momentous events. To our knowledge, this is the first reported case of myocarditis associated with cobra envenomation. Physicians should be familiar with potential life-threatening cardiac effects of these toxins.

Snake Envenomation Simulating ST Elevation Myocardial Infarction

“…Research is lacking; however, many case studies have postulated that snake venom may have thrombotic and vasoconstricting properties along with inflammatory components. 3,4 Bashir and Jenkins postulate that snake venom from vipers contains endopeptidases that can deplete coagulation factors leading to a hypercoagulable state. 3 This consumption of coagulation factors can lead to small or large occlusions explaining myocardial infarction.…”

“…3 Another study reported a case of MRI-confirmed myocarditis mimicking an STEMI. 4 Hypersensitivity and inflammatory reaction to cardiac myocytes were postulated to be the causes of this myocarditis.…”