Acute Coronary Syndrome From Green Snake Envenomation |
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| Authors: | Rangashamaiah Sriranga P. Sudhakar Bhairappa Shivakumar S. Shankar Cholenahalli Nanjappa Manjunath |
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| Affiliation: | 1. Faculty of Medicine, Department of Emergency Medicine, Mersin University, Mersin, Turkey;2. Faculty of Medicine, Department of Hematology, Mersin University, Mersin, Turkey;3. Faculty of Medicine, Department of Biostatistics and Medical Informatics, Mersin University, Mersin, Turkey;1. Department of Pharmacy, Baptist Health, Montgomery, Alabama;2. University of Massachusetts Medical School, Worcester, Massachusetts;3. School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania;4. State University of New York, Upstate Medical University, Syracuse, New York;1. Department of Pediatrics, Monroe Carell Jr. Children''s Hospital at Vanderbilt, Nashville, Tennessee;2. Division of Pediatric Emergency Medicine, Department of Pediatrics, Monroe Carell Jr. Children''s Hospital at Vanderbilt, Nashville, Tennessee;3. Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee;1. Division of Emergency Medicine, Temecula Valley Hospital, Temecula Valley, California;2. University California San Diego, La Jolla, California;1. Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas;2. Carolina Children''s Eye Care, Greensboro, North Carolina |
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| Abstract: | BackgroundSnake bite is a grossly underreported public health issue in subtropical, tropical suburban, and rural areas of Africa and South Asia. In literature, ophitoxemia (snake bite envenomation) as a cause of acute coronary syndrome (ACS) is limited to very few case reports. Viper envenomation is the most common cause of ACS among snake bites. We report the first case of unstable angina caused by Colubridae snake bite (Ahaetullanasuta, commonly called green snakes) in a young man without comorbidities.Case ReportA young healthy man had a green snake bite that was camouflaged in the green fodder. He was managed elsewhere with anti-snake serum. He developed acute chest pain and breathlessness on day 3 of his treatment. Electrocardiogram (ECG) showed biphasic T wave inversions suggestive of type A Wellens pattern in the anterior chest leads (V1–V4). He was treated for ACS medically outside and was referred to our institute for further management on the following day. ECG and cardiac enzymes were normal. The echocardiogram showed no regional wall motion abnormality. Computed tomography coronary angiography showed normal epicardial coronaries. He was discharged in stable condition and asymptomatic at 2 months follow-up.Why Should an Emergency Physician Be Aware of This?ACS after a snake bite is not limited to venomous snakes. The diagnosis should be considered promptly even with a nonvenomous snake bite, especially in those with typical symptoms and ECG changes. The time interval between snake bite and development of ACS can be long and warrants prolonged medical supervision. |
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| Keywords: | snake bite envenomation acute coronary syndrome Colubridae |
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