Retrospective Analysis of Cardiotoxic Scorpion Envenomation in Konkan Region of Western India with Special Reference to Echocardiography

Abstract

Introduction: Mortality due to scorpion sting is high in rural India as preference is given to traditional healers above hospitalisation. In rural Indian settings where there is a lack of diagnostic facilities Electrocardiogram (ECG) was supposed to be the only test to diagnose cardiotoxicity. However, we proposed to study Echocardiography (ECHO) serially in scorpion sting cases for classifying them into mild, moderate and severe envenomation. Aim: To study serial changes of cardiac dimensions on ECHO in cardiotoxic scorpion sting patients. Materials and Methods: This study was a retrospective and cross-sectional analysis of 925 patients stung by scorpion, admitted from January 2011 to December 2017 at BKL Walawalkar Hospital, Chiplun, Maharashtra, India. All patients were classified into mild, moderate and severe envenomation based on clinical findings and electrocardiography. All patients had ECHO done on admission but only 81 severely or moderately envenomed had complete records of ECHO readings. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 21.0 (SPSS Inc., Chicago, USA). Data has been presented as mean and Standard Deviation (SD) for all the ECHO measurements. Results: In 81 patients, ECHO on admission showed severe Left Ventricular (LV) dilatation. There was significant reduction in LV size (3.69 cm to 3.025 cm for systolic and 4.19 cm to 3.82 cm for diastolic, p-value <0.001 for both) in subsequent ECHOs, showing improvement in cardiac status and LV function {Ejection Fraction (EF) 28.17% to 43.31%, p-value=0.002} with normal coronary angiography. Conclusion: Diagnosis of cardiotoxicity, following scorpion sting, is challenging on ECG. In present study, LV dimensions on serial 2D ECHO were studied. After the sting, LV dysfunction occurs initially and it is completely reversible on subsequent serial ECHO.