Cardiovascular manifestations and patient outcomes following snake envenomation: a pilot study

Abstract

Cardiotoxicity in snake envenomation has not been adequately explored in the literature. This retrospective, observational study analysed clinical profiles and cardiovascular effects (CVE), with associated outcomes, in snake envenomation. Thirty-four patients were recruited between April 2014 and October 2017. Cardiovascular involvement was seen in 24 (70.6%) patients. Electrocardiographic changes included prolonged QTc (62.5%), T-wave inversion (37.5%) and tall T-waves (12.5%). Hospital stay was 7.2 (SD ¼ 5.3) days and 4.4 (SD ¼ 2.4) days in CVE and non-CVE groups respectively (P value ¼ 0.04). Mechanical ventilation was required only in nine of the CVE group (37.5%; P value ¼ 0.03). Shock was observed in seven patients (20.6%). Two of the patients in the CVE group (5.9%) died (P value ¼ 1.0); the majority had good outcomes with early administration of anti-venom serum and appropriate supportive measures. Thus, inpatient stay and mechanical ventilation were significantly increased in snake envenomation with CVEs, especially where an underlying co-morbidity existed.

Structural changes in the heart tissue of rats under conditions of acute intoxication with Vipera berus berus venom

“…The defining features of the structural organization of the myocardium were zones of massive hemorrhages, in some places the hemorrhages were of a diffuse character with impregnation of the heart muscle tissue. Erythrocytes often 4), collagen fibers ( 5), dissection of myocardial muscle fibers (6). Picro Sirius Red/Fast Green.…”

“…Histological organization of the heart of rats under the influence of Vipera berus berus venom. W ave-like orientation of myocardial muscle fibers (1), sarcolemma destruction zone (2), fibroblasts (3), hydropic dystrophy of Purkinje cells (4), collagen fibers ( 5), blood vessel lumen (6). Picro Sirius Red/Fast Green.…”

“…According to the literature, the basis of the pathogenesis of myocardial infarction due to bites of snakes of the Viperidae family is also a violation of oxygen supply to cardiomyocytes due to excessive hemolysis of erythrocytes, vasoconstriction of coronary vessels due to significant production of endothelin and the influence of venom safatoxins. Scientists note that the development of myocarditis with pronounced necrosis of contractile myocytes, hemorrhages and accumulation of blood clots in the vessels of the microcirculatory channel of the heart muscle is possible [6,15,23]. L. O. Simoes and co-authors [22] studied the effect of Crotalus durissus cascavella venom on the cardiovascular system of rats.…”

A Retrospective Cohort Study of Cobra Envenomation: Clinical Characteristics, Treatments, and Outcomes

“…Snake venom contains a number of proteins and peptides, such as phospholipase A, that exert hypotensive effects via various mechanisms [ 34 ]. Cardiovascular effects were described in most patients in an Indian study of snake envenomation [ 35 ].…”

Pulmonary involvement from animal toxins: the cellular mechanisms

“…cardiodepression, myocarditis, and myocardial infarction [9][10][11][12][13]; nephrotoxicity leading to volume overload [14,15]; neurotoxicity leading to respiratory muscle paralysis and ventilatory failure [16,17], and neurogenic pulmonary edema [18]. These causes of pulmonary injuries are mentioned elsewhere.…”