Cardiac complications are not prominent features of snake bite and the clinical picture is usually dominated by neurological, haematological and vascular damage by the snake bite toxins. Myocardial involvement is seen on occasions and may rarely contribute to morbidity and mortality. T wave abnormalities are the most common manifestation of myocardial involvement, although ST segment depression, QRS prolongation and AV conduction defects may also be seen rarely. ECG changes are usually transient but when persistent they are attributed to direct myocardial damage due to the toxin [1], One such case who showed these rare ECG changes following snake bite is reported. Case Report 61 year old female patient, not a known case of ischaemic heart disease, hypertension, diabetes mellitus or any other illness was hospitalised with the history of snake bite over the left foot. She had tingling sensation and numbness over the limb up to knee joint associated with progressive swelling upto mid calf region in next 6 hours. Clinical examination revealed an elderly lady, afebrile, having irregularly irregular pulse of 1487min and BP110/70 mm Hg. Systemic examination was not contributory. Investigation showed abnormal coagulation parameters (BT-8′20” CT-25′), platelet count 1,80,000/cmm, Hbllgm/dl, TLC 7600/cmm, blood urea 30 mg/dl, serum creatinine 0.6 mg/dl, cardiac enzymes as available were SGOT 30 IU/1 and SGPT 18 IU/l. Serial estimation over the next 3 days did not show any abnormalities in enzyme levels. Other investigations like serum electrolytes, serum calcium, prothrombin time and X-ray chest were within normal limits. Fibrinogen and fibrinogen degradation product estimation could not be done. ECG showed an irregular rhythm, junctional ectopics. RBBB and ST depression of 1-4 mm (Fig-1). Patient was managed with anti-snake venom, xylocard and supportive measures. Pulse rate returned to normal in next 48 hours while coagulation parameters reverted to normalcy in 96 hours. Patient made an uneventful recovery. Serial ECG showed reversal to sinus rhythm in 48 hours. Open in a separate window Fig. 1 Cardiac involvement in snake bite