AI Article Synopsis
- Snake bites are an underreported public health concern in certain regions, particularly in Africa and South Asia, with limited cases documented linking nonvenomous snake bites to acute coronary syndrome (ACS).
- A case report highlights a young, healthy man who developed unstable angina after being bitten by a green snake, demonstrating that ACS can occur even with nonvenomous snake envenomation.
- Emergency physicians should recognize that ACS can arise from any snake bite, not just those from venomous species, and should monitor patients closely for symptoms and ECG changes, as the onset of ACS may take time after the bite.
Article Abstract
Background: Snake 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 Report: A 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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| http://dx.doi.org/10.1016/j.jemermed.2020.10.024 | DOI Listing |
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