Myocardial Infarction after Snakebite Envenomation: A Scoping Study.

Abstract

Despite underreporting and "dry" bites (bites by venomous snakes without envenoming), snake envenomation is a cause of high morbidity and mortality in the suburban and rural areas of tropical and subtropical world. In addition to local effects at the site of the bite, envenomation affects almost all the tissues in the body both primarily or secondarily. Envenomation is known to cause cardiotoxicity. Multiple case reports of myocardial infarction (MI) following snake bites have been reported. We hereby present the first systematic review of such cases. Our review revealed that MI following envenomation is mostly reported in young adult males from tropical and subtropical world with no history of coronary artery risk factors. Most of the cases presented 60 minutes after the bite. Among the cases that reported electrocardiography (EKG) findings, 63% had ST-segment elevation. 88% of the cases had elevated troponin levels. 75% of the reported echocardiograms had wall motion abnormality. All patients who had emergent coronary angiography were noted to have a "culprit" vessel. 25% of the cases suffered cardiac arrest and 25% subsequently passed away. The pathophysiology of MI following envenomation is multifactorial. When MI is suspected, coronary angiography should be considered after hemodynamic stability and anti-venom therapy is ensued.