title: Echocardiography guided therapy for myocarditis after scorpion sting envenomation.
abstract: OBJECTIVE
  This study was to evaluate echocardiographic findings and its usefulness in clinical management of patients with scorpion sting envenomation.
  
  
  METHODS
  A total of 84 consecutive patients were prospectively studied. The data included demographics, at the time of presentation to the hospital, the clinical features, echocardiographic findings, admission to intensive care unit, use of inotropic medication, time to discharge, and mortality.
  
  
  RESULTS
  Out of 84 patients studied 60 patients (71.4%) had echocardiographic evidence of myocarditis (LVEF <50%). Majority of patients had LVEF <40% (50 patients, 83.3%). Severe LV dysfunction (LVEF <30%) was noted in 20 patients (33.3%). No patient had significant valvular regurgitation. RV dysfunction was noted in half of the patients who had LV dysfunction. RV dysfunction was not seen in isolation. Twenty four patients without evidence of myocarditis on echocardiography were observed in general wards and were discharged in 24 to 48 hours of admission. Ten patients with mild LV dysfunction (LVEF 50-40%) and 20 patients with moderate LV dysfunction were observed in high dependency units with regular monitoring for 24 to 48 hours. Only 3 patients were put on inotropics support and others could be discharged in 72 to 96 hours. All the patients with severe LV dysfunction and moderate LV dysfunction with significant RV dysfunction were admitted in intensive care unit irrespective of symptoms (Total 30 patients). These patients were put on inotropics support. Among severe LV dysfunction group, 4 patients required ventilator support and 2 (2.3%) patients died with refractory shock and multi-organ failure. Tachycardia, muffled and or gallop heart sounds and hypertension didn't predict presence of LV dysfunction. Persistent hypotension requiring inotropics support was a marker of severe LV dysfunction.
  
  
  CONCLUSIONS
  Echocardiography is a useful tool in emergency to assess LV function in patients with scorpion sting envenomation. It can guide therapy by identifying patients with severe LV dysfunction.
authors.affiliation: Assistant Professor, Department of Cardiology, Rajiv Gandhi Super Speciality Hospital (A super speciality unit of Raichur Institute of Medical Sciences) , Raichur, India .
authors.forename: Suresh V
authors.initials: SV
authors.lastname: Sagarad
authors.affiliation: Associate Professor, NMC & H , Raichur, India .
authors.forename: Sudha Biradar
authors.initials: SB
authors.lastname: Kerure
authors.affiliation: Professor, Department of Pathology, NMC & H Raichur, India .
authors.forename: Balaramsingh
authors.initials: B
authors.lastname: Thakur
authors.affiliation: Associate Professor, NMC & H & Consulting Physician SHRC , Raichur, India .
authors.forename: S S
authors.initials: SS
authors.lastname: Reddy
authors.affiliation: Consluting Pediatrician, RGSSH , Raichur, India .
authors.forename: Balasubramanya
authors.initials: B
authors.lastname: K
authors.affiliation: Consulting Pathologist, RGSSH , Raichur, India .
authors.forename: R M
authors.initials: RM
authors.lastname: Joshi
keywords: Echocardiography; Envenomation; Myocarditis; Scorpion