+Ophitoxaemia and myocardial infarction--the issues during primary angioplasty: a review

Area of Science:

• Cardiology
• Toxicology
• Emergency Medicine

Background:

• Snakebites, particularly from India's 'Big four' (cobra, viper, krait, sea snake), are a significant health concern in Kerala.
• Myocardial infarction (MI) post-snakebite is infrequently reported, with viper bites being the most common cause.

Observation:

• This report details the second documented case of primary angioplasty performed for snakebite-induced MI.
• The patient's case presented unique challenges, including differentiating between thrombus and vasospasm, assessing bleeding parameters, and evaluating tolerance to antiplatelet and anticoagulant therapies.

Findings:

• The procedure necessitated careful consideration of potential complications such as severe bleeding due to high-dose heparin and glycoprotein IIb/IIIa inhibitors.
• Concerns were raised regarding the risk of acute kidney injury from venom nephrotoxicity compounded by contrast media used during angioplasty.

Implications:

• This case underscores the complex management of MI in snakebite patients, balancing reperfusion therapy with coagulopathy and nephrotoxicity risks.
• Further research and literature review are needed to establish optimal treatment protocols for these challenging cases.