Case report: Acute myocardial infarction complicating a viper bite.

Abstract

Abstract. Myocardial infarction is a rare complication of snakebite. The present report describes a 40-year-old Jordanian farmer who developed an acute myocardial infarction several hours after a snakebite. The diagnosis of myocardial infarction was confirmed by a typical history of retrosternal chest pain, characteristic electrocardiographic changes, and elevated serum creatinine kinase (MB-CK). The patient had no risk factors for coronary artery disease and the coronary arteries were normal on cardiac catheterization. The possible mechanisms leading to myocardial infarction following snakebite are discussed.

Kounis syndrome (allergic angina and allergic myocardial infarction): A natural paradigm?

“…Adrenaline administration which can induce acute myocardial infarction [103] and venom hemorrhagins or endothelins [104] which can also induce coronary artery spasm have been definitely excluded. However, in patients with overt or quiescent pre-existing coronary artery disease or endothelial dysfunction, acute allergic episodes can induce plaque damage or artery spasm manifesting as type II or type I variant of Kounis syndrome, respectively.…”

Cardiac and hemodynamic features following snakebite in Nigeria

“…Recently a number of studies have reported that elevated levels of UA are associated not only with the presence of cardiovascular disease but also with poor prognosis in the setting of stable coronary artery disease (CAD) [6] acute MI [3][4][5], heart failure (HF) [7], stroke [8], metabolic syndrome (MS) [9] and in the patients without coronary artery disease [10].…”

“…The majority (94%) was envenomed by carpet viper but even among the few victims of burrowing asp and puff adder (4.6%), snakes known to possess cardiac toxins in their venom [2,3], myocardial ischaemia was not confirmed. Coagulopathy-induced bloody pericardial tamponade and acute myocardial infarction have very rarely complicated other viper bites [5][6][7] but evidence of myocardial ischaemia from carpet viper poisoning was obtained from elevated serum cTnT in only 2% of cases here. The only other systematic study using ECG and cTnT also concluded myocardial damage is uncommon following elapid snakebites in Papua New Guinea [8].…”

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

“…Even though ST-segment changes in this patient are compatible with myocarditis (diffuse, concave, with PR depression), one should consider acute coronary syndrome from thrombosis or coronary spasm, which has been reported in hematologic toxin snakebite [14-16]. Retrospectively considering the coronary angiogram at the time of admission to rule out coronary artery diseases, the temporal relation of the ST-segment and cardiac marker normalizations in this case suggest the diagnosis of myocarditis rather than acute coronary syndrome.…”