title: +Ophitoxaemia and myocardial infarction--the issues during primary angioplasty: a review.
abstract: 'The Big four' are the most poisonous snakes in India, and especially in Kerala. These include the cobra, the viper, the krait and the sea snake. Most of the poisonous snakebites in India occur in Kerala. We believe there are only a few reports of myocardial infarction after snakebites and most of these are viper bites. We believe this is the second case of primary angioplasty for a snakebite. There are at least a few potential issues in performing a primary angioplasty in a snakebite case, namely (1) Is it a thrombus or a spasm? (2) Are the bleeding parameters deranged? Will the patient tolerate tirofiban and other glycoprotein (GB) 2b3a inhibitors? Will he develop dangerous bleeding due to the high dose of heparin needed? Further, would we save the patient from myocardial infarction only to lose him to renal failure, both due to the nephrotoxicity of the venom, the kidney being further damaged by the contrast media used for the angioplasty? We discuss all these issues as they crossed our mind, and hope it will help further treatment in others. We would like to review the available literature on these points and describe a recent case of ours.
authors.affiliation: Department of Cardiology, Medical College Hospital, Trivandrum, Kerala, India.
authors.forename: Prabha Nini
authors.initials: PN
authors.lastname: Gupta
authors.affiliation: Department of Cardiology, Medical College Hospital, Trivandrum, Kerala, India.
authors.forename: Jinesh
authors.initials: J
authors.lastname: Thomas
authors.affiliation: Department of Cardiology, Medical College Hospital, Trivandrum, Kerala, India.
authors.forename: Preetham Kumar
authors.initials: PK
authors.lastname: Francis
authors.affiliation: Department of Cardiology, Medical College Hospital, Trivandrum, Kerala, India.
authors.forename: Sajith Vamadevan
authors.initials: SV
authors.lastname: Shylaja
mesh_terms: D017130:Angioplasty; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006470:Hemorrhage; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000628:therapy; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D012909:Snake Bites / Q000150:complications / Q000188:drug therapy; D012910:Snake Venoms; D012911:Snakes; D000077466:Tirofiban; D014443:Tyrosine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000997:Antivenins; D005343:Fibrinolytic Agents; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D012910:Snake Venoms; D014443:Tyrosine; D006493:Heparin; D000077466:Tirofiban