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Published on: June 7, 2018
Scorpion venom cardiomyopathy
E B Kumar1, R S Soomro, A al Hamdani
1Department of Cardiology, King Fabad Hospital, Al Baha, Saudi Arabia.
Insights
Scorpion stings can cause serious heart problems in children, affecting left ventricular function. Echocardiography helps monitor cardiac function, with prompt improvement indicating a better prognosis.
Area of Science:
- Pediatric Cardiology
- Toxicology
- Echocardiography
Background:
- Scorpion stings are a significant health concern in children, potentially leading to cardiac complications.
- Myocardial dysfunction following scorpion envenomation requires thorough investigation and monitoring.
Purpose of the Study:
- To evaluate cardiac function in children with scorpion stings using serial echocardiography.
- To identify echocardiographic predictors of myocardial toxicity and prognosis in pediatric scorpion sting cases.
Main Methods:
- Serial echocardiography was performed on 30 children with scorpion stings.
- Children were categorized into two groups based on initial left ventricular function: normal and compromised.
- Ejection fraction, fractional shortening, left ventricular end-systolic dimension, and interventricular septal thickening fraction were assessed.
Main Results:
- 12 children (group 2) presented with compromised left ventricular function (EF < 0.55, FS < 27%).
- Group 2 showed increased left ventricular end-systolic dimension and depressed interventricular septal thickening fraction compared to group 1.
- Nine children in group 2 improved within 24-48 hours; one child died, and another showed slow recovery.
Conclusions:
- Myocardial toxicity is a frequent and severe complication of scorpion stings in children, predominantly affecting systolic function.
- Serial echocardiography is valuable for tracking left ventricular function changes and clinical recovery.
- Children with persistent cardiac dysfunction beyond 48 hours need close monitoring due to higher risk.
Abstract:
Cardiac function was evaluated by serial echocardiography in 30 children affected by scorpion stings. They could be separated into two groups on the basis of the initial echocardiogram. Group 1, consisting of 18 children, had normal left ventricular function, whereas group 2, consisting of 12 children, showed compromised left ventricular function (ejection fraction less than 0.55; fractional shortening less than 27%). In group 2 the left ventricular end-systolic dimension was increased significantly and the interventricular septal thickening fraction was depressed significantly, compared with group 1. Nine children in group 2 showed improvement in all measurements of contractility, usually within 24 to 48 hours. Of the remaining children, one showed no echocardiographic changes and subsequently died. Another child made a slow improvement over several weeks. We conclude that myocardial toxicity is a common and serious complication of scorpion stings in children. Systolic function appears to be affected predominantly. Serial echocardiography is useful to follow changes in left ventricular function, which are generally matched by clinical improvement. Patients who fail to improve within 24 to 48 hours require particularly close observation.
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