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

doi:10.18203/2320-6012.ijrms20191545

Authors

Sandeep Singh Department of General Medicine, NSCB Medical College, Jabalpur, Madhya Pradesh, India
Abhijit Pall Department of General Medicine, NSCB Medical College, Jabalpur, Madhya Pradesh, India
Rupesh Singh Kirar Department of General Medicine, NSCB Medical College, Jabalpur, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20191545

Keywords:

Cardiotoxicity, Electrocardiogram, Snake bite

Abstract

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.

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References

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‐function 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.