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Acute Myocardial Infarction Following Androctonus crassicauda Envenomation: A Case Report
Banafshe Nouri1, Mohammad Fotouhi Siyah Pirani2, Alireza Malekrah1
1Department of Cardiology, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran, mazums.ac.ir.
Background:
Scorpion envenomation is a significant clinical problem in endemic regions. Cardiovascular complications are recognized, but acute myocardial infarction (AMI) following Androctonus crassicauda envenomation has not been previously reported.
Case Presentation:
A 20-year-old previously healthy male presented 2 h after a scorpion sting to the left ankle with severe chest pain, diaphoresis, and nausea. An ECG showed ST-segment elevations in the anterior leads, and cardiac biomarkers were elevated. Echocardiography revealed severe hypokinesia of the left ventricular apex and septum (EF 30%). The patient received intravenous thrombolysis shortly after low-dose polyvalent antivenom, with rapid improvement. Coronary angiography was not performed; thus, alternative mechanisms such as coronary vasospasm, toxin-induced myocarditis, or Kounis syndrome cannot be excluded.
Conclusion:
This case highlights a rare but potentially life-threatening cardiac complication of A. crassicauda envenomation. Clinicians in endemic regions should consider scorpion sting in the differential diagnosis of acute coronary syndromes in young patients without traditional cardiovascular risk factors. Early recognition, antivenom administration, and cardiovascular support are essential. Further studies are needed to clarify specific cardiotoxic mechanisms.
