Abstract
BackgroundRussell’s viper (Daboia russelli) bites lead to high morbidity and mortality in South Asia. Although variety of clinical manifestations is reported in viper bite victims, myocardial ischemic events are rare.Case presentationWe report a unique case of inferior wall ST elevation myocardial infarction due to a Russell’s viper bite over a vein with possible direct intravenous envenoming, in a young male with no past history or family history suggestive of ischemic cardiac disease, from Sri Lanka. In addition, the possible mechanisms of myocardial ischemia in snake bite victims are also briefly discussed.ConclusionImportance of the awareness of physicians on the rare, yet fatal manifestations of snake envenoming is highlighted.
Highlights
Russell’s viper (Daboia russelli) bites lead to high morbidity and mortality in South Asia
Envenoming by Russell’s viper (Daboia russelli) is common in Sri Lanka, in North Central Province where it leads to highest number of bites than any other snake [1], causing frequent systemic envenoming [2,3]
We report rapid development of inferior wall ST elevation myocardial infarction after Russell’s viper bite, probably due to direct intravenous venom injection
Summary
Envenoming by Russell’s viper (Daboia russelli) is common in Sri Lanka, in North Central Province where it leads to highest number of bites than any other snake [1], causing frequent systemic envenoming [2,3]. We report rapid development of inferior wall ST elevation myocardial infarction after Russell’s viper bite, probably due to direct intravenous venom injection. Kularatne [2] observed ischemic EEG changes only in four of the 336 Russell’s viper bite victims from Sri Lanka In this case, ST elevations in LIII and aVF leads of the first ECG (Figure 1) and the changes in subsequent ECGs which were consistent with the first ECG suggests an inferior wall myocardial infarction, probably due to occlusion of the right coronary artery. A high dose of venom entered via intravenous route leading to coronary thrombosis resulting in rapid development of myocardial infarction in this patient is a possibility. Extensive literature search failed to find studies investigating mechanism of leukocytosis following snake envenoming
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