Delayed-onset sinus node dysfunction in a child victim of Russell's viper bite

Area of Science:

• Cardiology
• Toxicology
• Neurology

Background:

• Russell's viper envenomation is known for coagulopathy and local tissue damage.
• Cardiac complications, particularly arrhythmias, are considered rare following Russell's viper bites.

Observation:

• A 14-year-old female presented with bleeding, ptosis, and muscle weakness after Russell's viper envenomation.
• Initial assessment revealed prolonged clotting time and international normalized ratio, with sinus tachycardia on electrocardiogram.
• Systemic symptoms improved following administration of antivenom serum.

Findings:

• Delayed-onset sinus node dysfunction, including sinus arrest and an atrial escape rhythm, was observed 24 hours post-envenomation.
• Electrocardiography confirmed significant bradycardia and arrhythmia development after initial recovery.
• These cardiac manifestations occurred despite successful treatment of systemic symptoms with antivenom.

Implications:

• This case underscores the potential for delayed cardiac arrhythmias following Russell's viper envenomation.
• Arrhythmias may manifest even after resolution of other systemic signs and successful antivenom therapy.
• Highlights the importance of prolonged cardiac monitoring in patients with Russell's viper bites.