Electrocardiographic abnormalities in patients bitten by taipans (Oxyuranus scutellatus canni) and other elapid snakes in Papua New Guinea
✍ Scribed by David G. Lalloo; Andrew J. Trevett; Nneka Nwokolo; Ian F. Laurenson; Sirus Naraqi; Isi Kevau; Michael W. Kemp; R.James L. Hooper; R.David G. Theakston; David Warrell
- Book ID
- 104164706
- Publisher
- Elsevier Science
- Year
- 1997
- Tongue
- English
- Weight
- 528 KB
- Volume
- 91
- Category
- Article
- ISSN
- 0035-9203
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✦ Synopsis
Envenoming by a number of species of snake may affect the myocardium or cause electrocardiographic changes; several different mechanisms have been proposed. In a prospective study of snake bite in Papua New Guinea, electrocardiographic changes were observed in 36 of 69 patients (52%) envenomed by the taipan (Oxyuranus scutellatus), 2 of 6 (33%) envenomed by death adders (Acanthophis sp.) and one envenomed by the brown snake (Pseudonaja textilis). Septal T wave inversion and bradycardias, including atrioventricular block, were the commonest abnormalities. There was no haemodynamic deterioration. The cause of these changes is uncertain; only 2 of 24 patients (8.3%) with electrocardiographic changes had markedly elevated plasma concentrations of cardiac troponin?; a sensitive and specific marker of myocardial damage. This suggests that myocardial damage is uncommon following bites by these species. Electrocardiographic abnormalities are most likely to have been caused by a direct toxic effect of a venom component upon cardiac myocyte function; in taipan bites, taicatoxin, a calcium channel blocker, might be responsible.