Echocardiographic Evaluation of the Response to Prazosin Treatment in Scorpion Sting

Abstract

Background Scorpion envenomation is a major public health problem in children that can induce lethal neurological, respiratory and cardiovascular complications. We aimed to evaluate cardiovascular complications with a follow-up of envenomed children for 1 month for possibility of incomplete recovery. Methods This was a prospective study conducted for children who presented with scorpion sting to Emergency and Intensive Care units. Demographic, clinical and laboratory findings of patients were recorded. Cases with suspected clinical and electrocardiographic manifestations of myocarditis were subjected to bedside echocardiography with follow-up at the end of the first week and the first month. Results Scorpion sting cases presented to our hospital were 81 cases during 1-year study; of them, 17 cases were stable without systemic manifestations after 12 h observation and discharged. Sixty-four cases suffered systemic organic complications and needed ICU admission; their mean age was 11.52 ± 3.74 and 64% of them were males. Twenty-eight of admitted cases showed manifestations of myocarditis and by echocardiography, all of them had evidence of left ventricular dysfunction. On follow-up, there was significant improvement at the end of first week and complete improvement at the end of first month except three cases who died due to pulmonary edema and cardiogenic shock. Conclusion Acute toxic myocarditis is a common and an important cause of morbidity and mortality following scorpion envenomation that necessitates early and aggressive management. High index of suspicion, serial electrocardiogram monitoring and echocardiography are three integrative lines required to recognize this serious complication. Lay summary Acute toxic myocarditis is a common cause of morbidity and mortality following scorpion envenomation that necessitates rapid medical treatment. We aimed to evaluate cardiovascular complications after scorpion sting with a follow-up of envenomed children for 1 month for possibility of incomplete recovery. Tachycardia was the most frequent observed cardiac sign followed by hypotension, while the least was bradycardia and hypertension. All cases with manifestations suggestive of myocarditis were evaluated by bedside two-dimensional echocardiography and showed evidence of left ventricular dysfunction, that begin to regress within 1 week of treatment unless progressive pulmonary edema and resistant cardiogenic shock occurred. On follow-up for survivors, complete improvement at the end of first month was noticed. Clinical suspicion, serial ECG monitoring and echocardiography are required for rapid and early diagnosis. Early use of prazosin therapy can prevent long-term residual damage as evidenced by echocardiographic evaluation.

Scorpion envenomation-associated myocarditis: A systematic review

“…S3 Table provides the excluded studies along with the reasons for exclusion. A total of 703 cases, consisting of 669 from 34 case series [ 13 , 14 , 18 , 26 , 27 , 34 – 62 ] and 34 from 30 case report articles [ 63 – 92 ], were extracted from the literature.…”

“…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 ,…”

“…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 , 78 – 89 ]. Shock or hypotension was seen in 45.8% (108 from 236) of patients [ 14 , 18 , 26 , 27 , 34 , 36 – 38 , 40 , 43 – 47 , 49 – 51 , 55 , 56 , 60 , 61 , 63 – 92 ]. Hypertension, despite cardiac dysfunction, was another notable presentation reported in some cases [ 34 , 50 , 51 , 57 , 60 , 66 , 74 , 76 , 82 , 84 ].…”

“…Shock or hypotension was seen in 45.8% (108 from 236) of patients [ 14 , 18 , 26 , 27 , 34 , 36 – 38 , 40 , 43 – 47 , 49 – 51 , 55 , 56 , 60 , 61 , 63 – 92 ]. Hypertension, despite cardiac dysfunction, was another notable presentation reported in some cases [ 34 , 50 , 51 , 57 , 60 , 66 , 74 , 76 , 82 , 84 ]. Sinus tachycardia was the most common ECG reading [ 13 , 27 , 34 – 38 , 43 , 44 , 47 , 53 , 58 – 62 , 64 – 66 , 68 , 69 , 74 , 75 , 77 – 89 ], followed by ST-T changes [ 13 , 27 , 34 , 36 – 38 , 44 , 47 ,…”