title: Electrocardiographic abnormalities in patients bitten by taipans (Oxyuranus scutellatus canni) and other elapid snakes in Papua New Guinea.
abstract: 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 T, 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.
authors.affiliation: Centre for Tropical Medicine, John Radcliffe Hospital, Oxford, UK.
authors.forename: D G
authors.initials: DG
authors.lastname: Lalloo
authors.forename: A J
authors.initials: AJ
authors.lastname: Trevett
authors.forename: N
authors.initials: N
authors.lastname: Nwokolo
authors.forename: I F
authors.initials: IF
authors.lastname: Laurenson
authors.forename: S
authors.initials: S
authors.lastname: Naraqi
authors.forename: I
authors.initials: I
authors.lastname: Kevau
authors.forename: M W
authors.initials: MW
authors.lastname: Kemp
authors.forename: R
authors.initials: R
authors.lastname: James
authors.forename: L
authors.initials: L
authors.lastname: Hooper
authors.forename: R
authors.initials: R
authors.lastname: David
authors.forename: G
authors.initials: G
authors.lastname: Theakston
authors.forename: D
authors.initials: D
authors.lastname: Warrell
mesh_terms: D000818:Animals; D001778:Blood Coagulation Disorders / Q000503:physiopathology; D001919:Bradycardia / Q000503:physiopathology; D009202:Cardiomyopathies / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D003402:Creatine Kinase / Q000097:blood; D004546:Elapid Venoms / Q000506:poisoning*; D017815:Elapidae; D004562:Electrocardiography; D006439:Hemodynamics; D006801:Humans; D009206:Myocardium / Q000378:metabolism; D010219:Papua New Guinea; D011446:Prospective Studies; D012909:Snake Bites / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D014336:Troponin / Q000097:blood; D020107:Troponin T
chemical_list: D004546:Elapid Venoms; D014336:Troponin; D020107:Troponin T; D003402:Creatine Kinase