Scorpion envenomation-associated myocarditis: A systematic review

Abstract

Background Scorpion envenomation is associated with several complications. One of the most serious complications is the cardiac involvement in the form of myocarditis that remains the main reason for mortalities associated with scorpion envenomation. The present review aims to elucidate clinical and paraclinical findings associated with scorpion-related myocarditis, and to explore different management strategies and subsequent outcomes. Methods We searched PubMed, Web of Science, Scopus, and Google Scholar for articles related to keywords of myocarditis associated with scorpion envenomation up to May 1, 2022. Each article was carefully reviewed by two independent researchers. In case of disagreement for inclusion, we sought a third researcher opinion. Results A total of 703 cases from 30 case reports and 34 case series were included in our review. Myocarditis associated with scorpion envenomation was usually reported in children presenting with cardiopulmonary symptoms including pulmonary edema (60.7%) and shock or hypotension (45.8%). The most common ECG findings are sinus tachycardia (82%) followed by ST-T changes (64.6%). The management typically included inotropes (especially dobutamine), prazosin, diuretics, nitroglycerine and digoxin, when indicated. Mechanical ventilation was required in 36.7% of the patients. Mortality in confirmed scorpion-related myocarditis cases is estimated at 7.3%. Almost all survived cases showed rapid recovery and improvement in the left ventricular function. Conclusion Even though myocarditis associated with scorpion envenomation is rare, it remains a serious and in some of cases a fatal consequence of scorpion sting. In case of relative presentations, particularly in envenomed children, diagnosis of myocarditis should be considered. Early screening using serial cardiac markers and echocardiography can guide the treatment. Prompt treatment that focuses on cardiogenic shock and pulmonary edema usually results in a favorable outcome.

Scorpion-Induced Acute Coronary Syndrome: A Stinging Complication

“…On 2D-TTE, there is regional or global hypokinesia with a depressed LVEF and dilated cardiac chambers. 14 Interestingly, the clinical presentation of the patient was significant for marked sinus bradycardia with ST-changes, unremarkable 2D-TTE and CAG. The pathophysiology of myocardial oxygen supply-demand mismatch resulting from tachycardia, hypotension, or hypertension is the maladaptive mechanism of T2MI according to the Fourth Universal Definition of Myocardial Infarction.…”

“… 11 In cases of cardiogenic shock, dobutamine is preferred as it augments myocardial contractility with minimal effect on PVR in a high catecholaminergic state. 14 …”

A Dança Descontrolada do Coração: Uma Revisão Sistemática sobre Taquiarritmias - Estratégias de Diagnóstico, Abordagens Terapêuticas e Desafios Emergentes

“…Outro fator de risco significativo é a febre reumática, uma condição inflamatória resultante de uma resposta imunológica inadequada a infecções estreptocócicas não tratadas. A febre reumática pode desencadear alterações estruturais no coração, aumentando assim a suscetibilidade à fibrilação atrial 4,5 .…”

“…À medida que a população envelhece, a incidência dessa arritmia aumenta substancialmente. A associação entre envelhecimento e fibrilação atrial está relacionada, em parte, às alterações degenerativas no tecido cardíaco e aos efeitos cumulativos de outros fatores de risco ao longo do tempo 4,5 .…”

Cytokines and their regulators in rat lung following scorpion envenomation

“…Some peptide toxins, as well as metallo- and serine proteases, can activate inflammatory reaction through stimulation of pro-inflammatory signaling cascades followed by cytokines synthesis, recruitment and activation of immune cells, whereas other may have immunosuppressive action and down-regulate inflammatory response. Lung injure accompanied by inflammation have been documented in cases of severe and fatal envenoming by L. abdullahbayrami and L. quinquestriatus related to L. macroctenus ( Borges and Lomonte, 2024 ; Fereidooni et al, 2023 ). The toxic effect of the poison of L. macroctenus on the kidneys was proven in the study of Matkivska R. with co-authors.…”