Electrocardiographic abnormalities in patients bitten by taipans (Oxyuranus scutellatus canni) and other elapid snakes in Papua New Guinea.
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.
Lalloo
D G
DG
Centre for Tropical Medicine, John Radcliffe Hospital, Oxford, UK.
Trevett
A J
AJ
Nwokolo
N
N
Laurenson
I F
IF
Naraqi
S
S
Kevau
I
I
Kemp
M W
MW
James
R
R
Hooper
L
L
David
R
R
Theakston
G
G
Warrell
D
D
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
D004546:Elapid Venoms; D014336:Troponin; D020107:Troponin T; D003402:Creatine Kinase