Scorpion Sting: A Hurt to the Heart Reported in a Tertiary Care Hospital in Central Rural India

Abstract

Scorpion stings are painful but harmless and are rarely life-threatening. There is emerging evidence of the association of electrocardiographic (ECG) changes in patients following scorpion stings. We report a case of scorpion sting in a patient in central rural India and provide a review of similar published cases. A 55-yearold previously healthy female was hospitalized in the department of medicine at our institute within two hours of a scorpion sting. She presented with severe pain at the site of the sting and profuse sweating. Her routine investigations (complete blood count renal function test, liver function tests, and arterial blood gas analysis) results were normal. Her electrocardiogram revealed acute myocardial infarction, and serial ECG showed ST and T-wave changes. On laboratory investigation, it was found that her troponin-T was positive and creatinine phosphokinase levels were raised. There was apical wall hypokinesia on transthoracic echocardiography on Day 1 and Day 2. The patient recovered completely and was discharged within five days of hospitalization once her symptoms improved. This case highlights the severe presentation of scorpion stings in otherwise healthy females. The chances of improved clinical symptoms are more if prazosin (125-250 ug) is administered early after scorpion-stung patients experience cardiac abnormalities. This treatment can dramatically alter scorpion envenomation's morbidity and mortality depending on the duration after which it is administered. This case raised our interest due to cardiovascular manifestations in the patient and the early treatment with prazosin for the scorpion sting. Hence, this case was reported for the purpose of creating awareness among physicians and protecting the more vulnerable population.

Scorpion-Induced Acute Coronary Syndrome: A Stinging Complication

“…Other elements include phospholipases, hyaluronidases, and hemolysins. 10 , 11 The toxic compounds can elicit mild to severe symptoms. The venom is capable of causing coronary artery spasm, platelet aggregation and thrombosis, reduced Na-K-ATPase activity, increased endogenous epinephrine, norepinephrine, bradykinin levels and anaphylaxis.…”

“…The venom is capable of causing coronary artery spasm, platelet aggregation and thrombosis, reduced Na-K-ATPase activity, increased endogenous epinephrine, norepinephrine, bradykinin levels and anaphylaxis. 11 , 12 These symptoms reported are emesis, diaphoresis, hypersalivation, tachy-, bradyarrhythmias, and convulsions. 11 The most reported cardiac manifestations are hypertensive crises (30-77%), T1MI, T2MI, myocarditis, heart failure with pulmonary edema (25%), and cardiogenic shock.…”

“… 11 , 12 These symptoms reported are emesis, diaphoresis, hypersalivation, tachy-, bradyarrhythmias, and convulsions. 11 The most reported cardiac manifestations are hypertensive crises (30-77%), T1MI, T2MI, myocarditis, heart failure with pulmonary edema (25%), and cardiogenic shock. 13 A systematic review of 703 cases identified sinus tachycardia (82%) and ST-T wave changes (64.6%) on ECGs as the most frequent electrocardiographic abnormalities, which represent cardiac injury, ischemia or myocardial strain.…”

Cardiopulmonary Complications Associated With Scorpion Poisoning in Pediatric Patients

“…A causa da cardiomiopatia se associa a altas concentrações de catecolaminas, o que leva a um aumento da pós-carga (aumento da resistência vascular sistêmica), taquicardia, hipertensão arterial, diminuição da contração miocárdica (alterações da membrana pelas toxinas, diminuição do fornecimento de oxigênio) desencadeando uma disfunção ventricular esquerda (podendo evoluir para disfunção ventricular direita), o que leva a um baixo débito cardíaco e a um choque cardiogênico (SHASHANK BANAIT et al, 2022).…”

“…A isquemia miocárdica ocorre por reações desencadeadas em resposta as altas concentrações de catecolaminas, como a vasoconstrição das artérias coronarianas, além de lesões endoteliais que induzem a agregação plaquetária e formação de trombose intravascular, culminando numa diminuição de fornecimento de oxigênio para os cardiomiócitos. Além disso, há um aumento da demanda de oxigênio nas células cardíacas em decorrência da maior contratilidade miocárdica em resposta a disfunção ventricular esquerda provocada pelo envenenamento, com isso há uma maior probabilidade de infarto miocárdico, já que a demanda está aumentada e a oferta está diminuída em decorrência da oclusão coronariana (SHASHANK BANAIT et al, 2022).…”