Abstract
Background: Snake bite is a common and frequently devastating environmental and occupational disease, especially in rural areas of tropical developing countries. The present study was undertaken to evaluate the effect on cardiac profile in patients with snake envenomation and its complications. Methods: A total of 200 patients with snake envenomation were enrolled in this study excluding patients having history of any cardiovascular disease, renal disease, coagulopathy, liver disease, neuromuscular disease and those cases who bitten by non-poisonous snakes. All patients underwent physical examination, laboratory, Electrocardiogram (ECG), X-ray of chest and echocardiogram investigations. Results: A total of 200 cases had envenomation having 116 (58%) of male subjects. Most common local signs were edema 187 (93.5%), tenderness 141 (70.5%), skin necrosis 81 (40.5%) and blistering 12 (6%). Severity of local envenomation was graded into mild 66 (33%), moderate 120 (60%) and severe 14 (7%) cases. Systemic manifestations were present in 83 patients of venomous bites. It includes that majorly 53 (26.5%) cases had vomiting, 44 (22%) cases had abdominal pain and 9 (4.5%) cases of hypotension. ECG manifestation showed 27 (13.5%), 6 (3%) and 1 (0.5%) patients had sinus tachycardia, sinus bradycardia and ventricular tachycardia respectively. While, 9 (4.5%) cases had T inversion alone in precordial leads. Mortality (3%) was observed in intracranial bleed, neurotoxicity and capillary leak syndrome. However, cardiovascular involvement was not responsible for mortality in any cases. Conclusion: In conclusion, ventricular tachycardia is one of the manifestations of snake envenomation. Moreover, sinus tachycardia is common cardiovascular sign which may not be due to cardiac causes. Mortality results conclude that, cardiovascular involvement could not be responsible for mortality in snake envenomation.
Highlights
Snake bite is one of the major public health problems especially in tropical and subtropical countries
A total of 200 patients with snake envenomation were enrolled in this study excluding patients having history of any cardiovascular disease, renal disease, coagulopathy, liver disease, neuromuscular disease and those cases who bitten by non-poisonous snakes
Systemic manifestations were present in 83 patients of venomous bites
Summary
Snake bite is one of the major public health problems especially in tropical and subtropical countries. 15% of 3000 species of snakes found worldwide are considered to be dangerous to humans Among those species 52 poisonous species found in India, majority of bites and consequent mortality is attributable to 5 species viz. Ophiophagus hannah (king cobra), Naja naja (common cobra), Daboia ruselli (Rossell’s viper), Bungarus caeruleus (krait) and Echis carinatae (saw-scaled viper). Cardiotoxicity is seen in many cases dying of severe viper bite This may occur in the form of sudden hypotension, cardiac arrhythmia, myocardial infarction and changes in the electrocardiogram mainly of ST segment and T wave. Methods: A total of 200 patients with snake envenomation were enrolled in this study excluding patients having history of any cardiovascular disease, renal disease, coagulopathy, liver disease, neuromuscular disease and those cases who bitten by non-poisonous snakes. Cardiovascular involvement could not be responsible for mortality in snake envenomation
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