From sting to pacemaker: a case of complete heart block following yellow scorpion envenomation-a case report

Scorpion envenomation is a significant medical concern in tropical and subtropical regions, with cardiovascular complications being among its most severe manifestations. While scorpion venom-induced cardiac dysfunction is well-documented, complete atrioventricular (AV) block is a rare occurrence. This case highlights a unique presentation of complete heart block following a yellow scorpion sting, emphasizing the importance of early recognition and management.

A 56-year-old Middle Eastern (Iranian) male presented to the emergency department with dizziness, syncope, and severe bradycardia following a yellow scorpion sting. Electrocardiographic evaluation revealed a complete atrioventricular block. Laboratory findings indicated elevated cardiac biomarkers, suggesting myocardial injury. Echocardiography demonstrated left ventricular dysfunction without significant structural abnormalities. The patient required temporary transvenous pacing for hemodynamic stabilization and was managed with supportive care, including intravenous fluids, atropine, and continuous cardiac monitoring. Over the course of hospitalization, his conduction abnormality resolved by permanent pacemaker, and he was discharged in stable condition.

This case underscores the potential for severe cardiac complications following scorpion envenomation, particularly conduction disturbances such as complete atrioventricular block. Although rare, healthcare providers should be aware of this life-threatening consequence and initiate prompt intervention to prevent adverse outcomes. Increased awareness and timely management can significantly improve prognosis in affected patients.