Acute Coronary Syndrome From Green Snake Envenomation

Area of Science:

• Cardiology
• Toxicology
• Emergency Medicine

Background:

• Snake bites are a significant public health concern in tropical and subtropical regions.
• Acute coronary syndrome (ACS) following snake envenomation is rare, typically associated with viper bites.
• This case highlights unstable angina in a young, healthy individual after a Colubridae (green snake) bite.

Observation:

• A young man presented with chest pain and breathlessness three days after a green snake bite.
• Electrocardiogram (ECG) revealed Wellens pattern (biphasic T wave inversions) in anterior leads.
• Initial cardiac workup, including ECG, enzymes, echocardiogram, and CT coronary angiography, was normal upon referral.

Findings:

• The patient was diagnosed with unstable angina secondary to a Colubridae snake bite.
• Despite initial normal cardiac investigations, the clinical presentation and ECG changes were indicative of ACS.
• The patient recovered fully with medical management and showed no symptoms at two-month follow-up.

Implications:

• ACS following snake bites is not exclusive to venomous species.
• Emergency physicians must maintain a high index of suspicion for ACS in snake bite victims presenting with relevant symptoms and ECG findings.
• Prolonged medical supervision is warranted due to the potential for delayed ACS onset after snake bites.