title: Cardiac tamponade in Russell viper (Daboia russelii) bite: case report with brief review.
abstract: BACKGROUND
  Coagulopathy after snake bite is well known; however, cardiac tamponade as a manifestation of coagulopathy is rare.
  
  
  OBJECTIVE
  To report a case of pericardial hemorrhage with cardiac tamponade after Russell viper bite.
  
  
  METHODS
  A 26-year-old man developed breathlessness after being bitten by a Russell viper. The clinical and laboratory follow-up of this case confirmed the clinical diagnosis of toxin-induced disseminated intravascular coagulation. Interestingly, pericardial hemorrhage with large pericardial effusion was evident clinically as well as on electrocardiogram and echocardiogram, as an initial presentation without any other bleeding manifestations. The patient developed cardiac arrest and was revived with cardiopulmonary resuscitation. Emergency pericardiocentesis was carried out. He was given fresh frozen plasma in addition to snake antivenin along with symptomatic management. On the third day of hospitalization, the patient's clinical and laboratory profile returned to normal and he was discharged on the fifth day.
  
  
  CONCLUSIONS
  Pericardial hemorrhage may be due to toxin-induced myocardial damage or pericardial vessel injury coupled with coagulopathy, possibly in conjunction with vasculitis or endothelial damage. Practitioners and physicians should suspect and search for pericardial effusion in snake bite victims who develop breathlessness, and treat it vigorously in addition to antivenin therapy.
authors: Sri Gokulam Hospitals & Research Institute, Salem, Tamil Nadu, India. maniansenthil@yahoo.co.in
authors: Subramanian
authors: S
authors: Senthilkumaran
authors: Ramachandran
authors: R
authors: Meenakshisundaram
authors: Ponniah
authors: P
authors: Thirumalaikolundusubramanian
mesh_terms: D000328:Adult; D000818:Animals; D002305:Cardiac Tamponade / Q000209:etiology*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D010490:Pericardial Effusion / Q000209:etiology*; D017840:Daboia; D012909:Snake Bites / Q000150:complications*