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Profile of cardiac complications of snake bite
K C Nayak1, A K Jain, D P Sharda
1Department of Medicine, S.P. Medical College, Bikaner.
Insights
Snake bites, particularly viperine, frequently cause cardiotoxicity and hemorrhagic manifestations. Cardiac disturbances like tachycardia and bradycardia are common, with a 10% mortality rate in severe cases.
Area of Science:
- Cardiology
- Toxicology
- Internal Medicine
Background:
- Snake bites represent a significant public health concern, with cardiac complications being a critical aspect of management.
- Understanding the cardiac profile in snake bite victims is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the cardiac profile in snake bite cases.
- To identify specific cardiac manifestations and their correlation with snake species and clinical presentation.
- To aid in the clinical management of snake bite-induced cardiac issues.
Main Methods:
- A study involving 30 snake bite cases.
- Routine and specific investigations including Electrocardiogram (ECG), Chest X-ray, and Serum Glutamic-Oxaloacetic Transaminase (SGOT) levels.
- Clinical assessment of hemorrhagic manifestations and cardiac rhythm disturbances.
Main Results:
- Viperine snake bites accounted for 93% of cases, with cardiotoxicity observed in 25% of these.
- Hemorrhagic manifestations were present in 70% of patients, while 30% exhibited cardiotoxicity.
- Common ECG findings included sinus tachycardia (36.7%), non-specific ST-T changes (16.7%), and myocardial ischemia (10%). Gallop rhythm was noted in 30% of patients.
- Mortality rate was 10%, with fatalities associated with bleeding and abnormal ECGs.
Conclusions:
- Snake bites, especially viperine, can lead to significant cardiotoxicity and hemorrhagic complications.
- Early presentation within 24 hours is common, and prompt cardiac evaluation is essential.
- Abnormal electrocardiographic findings and bleeding manifestations are indicators of poor prognosis in snake bite victims.
Abstract:
The present study was conducted in 30 cases of snake bite to understand fully the intricacies of the cardiac profile and to render help in the management of the problem arising out of them. All were subjected to routine and specific investigations (ECG, X-ray Chest, SGOT). The present study concluded that 57 per cent of patients of snake bite were in 2nd and 3rd decades of life. Viperine snake bite occurred in 93 per cent and elapide snake bite in 7 per cent of cases. Cardiotoxicity was seen in only 25 per cent patients with viperine bite. Seventy-six per cent of the patients presented within 24 hours of the bite. Seventy per cent of patients had haemorrhagic manifestations and 30 per cent had cardiotoxicity. The disturbance in heart rate was seen in 47 per cent, rhythm disturbance in 6.7 per cent, tachycardia in 36.7 per cent and bradycardia in 10 per cent cases. Hypertension was found in 6.7 per cent, hypotension in 16.7 per cent. Thirty per cent of patients had gallop rhythm and it persisted in 16.6 per cent patients till discharge. One patient had evidence of pulmonary edema and one had basal congestion. Cardiomegaly on chest X-ray was found in one patient and elevated SGOT titres were found in ten per cent. Common electrocardiographic changes were sinus tachycardia, sinus arrhythmia (6.6%), sinus bradycardia (10%), tall T-wave in V2 (3.3%), pattern suggestive of acute anterior wall infarction with reciprocal changes (3.3%), myocardial ischemia (10%), non-specific ST-T changes (16.7%) and atrioventricular block (3.3%). The mortality rate was 10 per cent and all these patients had bleeding manifestations and abnormal electrocardiograms.