Published: 2019-04-26

Study of electrocardiographic changes pattern in cases of snake bites in a tertiary care hospital of Mahakaushal area of central India

Sandeep Singh, Abhijit Pall, Rupesh Singh Kirar


Background: Snake bite is an occupational hazard for farmers and farm laborers in the Indian subcontinent. Most snake venom can adversely affect multiple organs. Various ECG changes have been reported in a large percentage of cases of snake bite (particularly viper and krait) from time to time. Thus, cardiotoxicity was studied with ECG.

Methods: This cross-sectional observational study was carried on 84 patients admitted in Ward/ICU, Department Of Medicine, NSCB Medical College, Jabalpur, India on patients of snake bite reporting from all over Mahakaushal area of central India from March 2017 to August 2018.

Results: The commonest manifestation in vasculotoxic snake bite was tachycardia (16.67%). On admission, ECG manifestations were 39.1% in poisonous bites were sinus tachycardia (17.8%), sinus bradycardia (9.5%), nonspecific ST-T changes (5.9%), AV block (3.5%) and sinus arrhythmia (2.3%) of all cases. These ECG changes were 2.3% in nonpoisonous patients. In symptomatic cases mortality was 19% with no mortality was seen in non-poisonous snake bite. There was significant difference between outcome of abnormal ECG group and normal ECG group patients (p <0.005).

Conclusions: There is significant impact of snake poisons on cardiovascular profile and ECG can be a useful tool to predict outcome.


Cardiotoxicity, Electrocardiogram, Snake bite

Full Text:



Sanford JP, eds. Snake bite. In: Cecile Text Book of Medicine. 20th ed. WB Saunders, London: 1996;2:1951-1953.

Warrell DA, eds. Animal toxins. In: Mansons Tropical Disease. 20th Ed. WB Saunders, London; 1996:468-515.

Dutta TK, Vijeth SR. Snake bite. In: API Medicine Update. Shanker PS: 1995;5:309-12.

Norris RL, Oslund S, Auerbach PS. Disorders caused by reptile bites and marine animal envenomations. In: Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, Harrison TR, eds. Harrison's Principles of Internal Medicine. 14th ed. Boston: McGraw-Hill; 1998:2544-2548.

MSA Nandimath V, Bandichhode S. A prospective study regarding cardiovascular manifestations following snake bite. Int J Adv Med. 2007;4(1):152-5.

Gupta P, Mahajan N, Gupta R, Gupta P, Chowdhary I, Singh P, et al. Cardiotoxicity profile of snake bite. JK Sci. 2013;15(4):169.

Angaji S, Houshmandi A, Zare Mirakabadi A. Acute effects of the iranian snake (naja naja oxiana) venom on heart. Biomacromolecular J. 2016;2(2):97-101.

Schamroth L. An introduction to electrocardiography. 7th ed. Oxford: Blackwell Science Ltd; 1990.

Banerjee RN. Progress in clinical medicine in India. Ahuja MMS, eds. 1st ed. Arnold Heinemann Publisher, New Delhi: 1978; 21: 36-179.

Bhargava RK, Hakim A, Shah PK, Mathur SB, Ujjwal JS. Disseminated intravascular coagulation in cases of snake bite (Echis carinatus). J Assoc Physicians India. 1976;24(10):671-5.

Bhat RN. Viperine snake bite poisoning in Jammu. J Ind Med Assoc. 1974;63(12):383-92.

Saini RK, Sharma S, Singh S, Pathania NS. Snake bite poisoning: a preliminary report. J Assoc Physicians India. 1984;32(2):195.

Sarangi A, Jena I, Sahoo H, Das JP. A profile of snake bite poisoning with special reference to haematological, renal, neurological and electrocardiographic abnormalities. J Assoc Physicians India. 1977;25(8):555-60.

Sokolovsky M. Structure‚Äźfunction relationships of endothelins, sarafotoxins, and their receptor subtypes. J Neurochemistry. 1992;59(3):809-21.

Reid HA. Venomous bite and sting. 18th Ed. FLBS and Bailliers Tindal Publication, London; 1982:546.

Nayak KC, Jain AK, Sharda DP, Mishra SN. Profile of cardiac complications of snake bite. Ind Heart J. 1990;42(3):185-8.

Wu WG. Cobra cardiotoxin and phospholipase A2 as GAG-binding toxins: on the path from structure to cardiotoxicity and inflammation. Trends Cardiovascular Med. 1998;8(6):270-8.

Mirajkar KK, More S, Gadag JR. Isolation and purification of a neurotoxin from Bungarus caeruleus (common Indian krait) venom: biochemical changes induced by the toxin in rats. J Basic Clin Physiol Pharmacol. 2005;16(1):37-52.

Sun JJ, Walker MJ. Actions of cardiotoxins from the southern Chinese cobra (Naja naja atra) on rat cardiac tissue. Toxicon. 1986;24(3):233-45.

Cher CD, Armugam A, Zhu YZ, Jeyaseelan K. Molecular basis of cardiotoxicity upon cobra envenomation. CMLS. 2005;62(1):105-18.

Saini RK, Singh S, Sharma S, Rampal V, Manhas AS, Gupta VK. Snake bite poisoning presenting as early morning neuroparalytic syndrome in jhuggi dwellers. J Assoc Physicians India. 1986;34(6):415.

Pahlajani DB, Iya V, Tahiliani R, Shah VK, Khokhani RC. Sinus node dysfunction following cobra bite. Ind Heart J. 1987;39(1):48.

Hafeez S, Majeed I. Cardiac arrhythmia as presentation of snakebite. JCPSP. 2004;14(1):48-9.

Anitha MS, Nandimath VA, Bandichhode ST. A prospective study regarding cardiovascular manifestations following snake bite. Int J Adv Med. 2017;4(1):152-5.