Echocardiographic changes during acute pulmonary edema subsequent to scorpion sting

Abstract

Acute pulmonary edema (APE) occurring after scorpion sting is the leading cause of death of the victims of scorpion envenomation. The APE origin is still questioned by physicians treating these patients. Based on echocardiographic study of 20 patients with severe envenomation treated in Ouargla Hospital resuscitation ward during the last four years, the APE etiology seems more likely cardiogenic, referring to cardiac symptoms confirmed by echocardiography although other mechanisms may also be involved. This hypothesis is further confirmed by the positive response of patients to the administration of dobutamine.

Scorpion envenomation-associated myocarditis: A systematic review

“…Symptoms and clinical findings associated with myocarditis included respiratory distress (tachypnea and/or dyspnea), mostly associated with pulmonary edema, cold or cyanotic extremities, hypotension or shock, increased heart rate, and gallop rhythm on heart auscultation. Among these, respiratory distress [ 26 , 28 , 34 , 36 – 38 , 40 , 43 – 48 , 51 , 59 , 63 – 71 , 73 – 92 ] and increased heart rate (tachycardia) [ 13 , 27 , 34 , 36 – 39 , 43 , 44 , 47 , 53 , 56 , 58 , 59 , 61 , 64 – 66 , 68 , 69 , 74 , 75 , 77 – 89 ] were the most common manifestations affecting 94.8% (145 from 153) and 82% (137 from 167) of the patients, respectively. In studies where the prevalence of pulmonary edema could be determined unequivocally, it was observed in 60.7% (246 from 405) of patients [ 13 , 27 , 34 , 36 – 39 , 42 – 44 , 47 , 48 , 51 , 56 , 58 , 59 ,…”

“…Among these, respiratory distress [ 26 , 28 , 34 , 36 – 38 , 40 , 43 – 48 , 51 , 59 , 63 – 71 , 73 – 92 ] and increased heart rate (tachycardia) [ 13 , 27 , 34 , 36 – 39 , 43 , 44 , 47 , 53 , 56 , 58 , 59 , 61 , 64 – 66 , 68 , 69 , 74 , 75 , 77 – 89 ] were the most common manifestations affecting 94.8% (145 from 153) and 82% (137 from 167) of the patients, respectively. In studies where the prevalence of pulmonary edema could be determined unequivocally, it was observed in 60.7% (246 from 405) of patients [ 13 , 27 , 34 , 36 – 39 , 42 – 44 , 47 , 48 , 51 , 56 , 58 , 59 , 64 – 66 , 69 , 75 ,…”

“…Echocardiography findings in the studies included regional or global hypokinesia [ 13 , 26 , 34 , 36 – 38 , 45 , 48 , 51 , 52 , 54 , 57 , 59 , 61 , 62 , 67 , 71 , 72 , 75 – 77 , 79 , 81 , 83 – 87 , 90 , 91 ], chamber dilation [ 45 , 53 , 59 , 68 , 69 , 73 , 76 , 80 ], decreased left ventricular ejection fraction (LVEF) [ 13 , 14 , 18 , 26 , 34 , 36 – 41 , 45 , 46 , 48 , 49 , 51 – 55 , 57 – 75 , 77 – 93 ], decreased fractional shortening (FS) [ 37 , 38 , 41 , 48 , ...…”

“…Standard heart failure treatment, including inotropes as well as diuretics to treat cardiogenic shock and pulmonary edema, was used in almost all studies. Dobutamine was the most widely used agent to treat shock in scorpion stings [ 13 , 14 , 18 , 26 , 35 , 36 , 38 , 40 , 41 , 43 , 45 , 46 , 48 , 49 , 56 , 58 , 61 – 64 , 67 , 68 , 71 , 73 , 78 , 80 , 81 , 83 , 84 , 86 – 89 , 92 ]. Mechanical ventilation was required in 35.2% (87 of 247) of cases to treat respiratory failure [ 14 , 18 , 26 , 34 – 38 , 40 , 43 – 45 , 47 , 57 , 61 – 71 , 73 – 83 , 85 – 92 ].…”

African Society of Toxinology: a new opportunity for integrating the control of envenomations in Africa

“…Epidemiological studies confirm the importance and severity of scorpion stings in Algeria (19). Simultaneously, clinical and therapeutic investigations show the diversity of the pharmacological action exerted by scorpion venom on the human cardiovascular and neurological systems (20,21).…”