title: The first description of cardiac magnetic resonance findings in a severe scorpion envenomation: Is it a stress-induced (Takotsubo) cardiomyopathy like?
abstract: There are more than 1 million cases of scorpion envenomation worldwide. Severe complications due to myocardial depression can happen in some patients, mainly children. A catecholamine-induced myocarditis probably causes this cardiac dysfunction. We describe a case of a 7-year-old boy with a severe scorpion envenomation complicated by pulmonary edema in which the cardiac magnetic resonance (CMR)was performed during the acute phase. The CMR showed an apical ballooning in the left ventricle associated with a left ventricle ejection fraction of 29% and a global edema of the midmyocardium and apical myocardiumin the T2-weighted triple inversion recovery images. The CMR was repeated after 7 months and showed complete recovery of the wall motion in the apical region and of the myocardial function (left ventricle ejection fraction, 60%) associated with normalization of the signal in the T2-weighted triple inversion recovery images. These clinical and laboratory findings, mainly the CMR images, are similar to those observed in stress-induced cardiomyopathy (Takotsubo) reinforcing the hypothesis that the catecholamine's excess has a pivotal function in the pathophysiology of the cardiac dysfunction in these 2 conditions.
authors.affiliation: Division of Emergency Medicine and Division of Cardiology of the Department of Internal Medicine of the Ribeirão Preto School of Medicine of the São Paulo University, São Paulo, Brazil. Electronic address: chmirand@yahoo.com.br.
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Miranda
authors.affiliation: Division of Emergency Medicine and Division of Cardiology of the Department of Internal Medicine of the Ribeirão Preto School of Medicine of the São Paulo University, São Paulo, Brazil.
authors.forename: Maria F
authors.initials: MF
authors.lastname: Braggion-Santos
authors.affiliation: Division of Emergency Medicine and Division of Cardiology of the Department of Internal Medicine of the Ribeirão Preto School of Medicine of the São Paulo University, São Paulo, Brazil.
authors.forename: André
authors.initials: A
authors.lastname: Schmidt
authors.affiliation: Division of Emergency Medicine and Division of Cardiology of the Department of Internal Medicine of the Ribeirão Preto School of Medicine of the São Paulo University, São Paulo, Brazil.
authors.forename: Antônio
authors.initials: A
authors.lastname: Pazin-Filho
authors.affiliation: Department of Pediatrics of the Ribeirão Preto School of Medicine of the São Paulo University, São Paulo, Brazil.
authors.forename: Palmira
authors.initials: P
authors.lastname: Cupo
mesh_terms: D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D002648:Child; D003287:Contrast Media; D004452:Echocardiography; D004562:Electrocardiography; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011654:Pulmonary Edema / Q000209:etiology; D065008:Scorpion Stings / Q000150:complications* / Q000188:drug therapy; D012605:Scorpions; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis* / Q000209:etiology*
chemical_list: D000997:Antivenins; D003287:Contrast Media