Cardiac toxicity a common complication of snakebite: JAPI study
Kerala, India: Snake bite, both vasculotoxic and neurotoxic, are associated with cardiac toxicity and not with increase in mortality, suggests a recent study in the Journal of the Association of Physicians of India. Also, the incidence of cardiac toxicity was found to be more frequent than previously thought.
Cardiac toxicity following snakebite has been reported previously but not studies in detail, especially the involvement in neurotoxic bites. The study by Sunil Kumar K, Department of Internal Medicine, Little Flower Hospital and Research Centre, Angamaly, Kerala, and colleagues evaluated the incidence of cardiac toxicity along with the difference between vasculotoxic and neurotoxic bites and analyzing the predictors for development of cardiotoxicity.
This prospective observational study was conducted from August 2015 to March 2017 at a tertiary referral hospital in Southern India which treats around 18 to 20 snakebite patients per month, of which 80-90% are due to vasculotoxic snakes. 96 patients who had snake bite envenomation were evaluated for features of cardiotoxicity with clinical features, ECG, echocardiogram and troponin-I levels.
Key findings of the study include:
- Cardiac toxicity was observed in 42.7% of patients, the majority were either ECG changes, noted in 34.3% and rise in troponin-I, noted in 21.9% of patients.
- Other changes included echocardiographic changes in 4.2%, and Takotsubo cardiomyopathy in 1%.
- There was no significant difference in the incidence of cardiotoxicity between the neurotoxic (41.7%) and vasculotoxic (42.9%) snake bites, even though the predominant changes seen in neurotoxic snake bites were ECG changes.
- There were no deaths in the current study.
- None of the demographic or clinical parameters studied could predict the development of cardiac events.
"Cardiac toxicity is a well defined complication of poisonous snake bite and incidence is more frequent than previously thought. Both vasculotoxic and neurotoxic snake bites are associated with cardiac toxicity and is not associated with increase in mortality," concluded the authors.
The study, "Cardiac Involvement in Vasculotoxic and Neurotoxic Snakebite – A not so Uncommon Complication," is published in the Journal of the Association of Physicians of India.