Myocardial Infarction as a Rare Consequence of a Snakebite

A healthy 28-year-old man with no history of cardiac disease and no cardiac risk factors presented to the hospital 2 hours after being bitten on his right hand by his pet snake. He was in anaphylactic shock and was rapidly resuscitated with fluids, inotropic support, intramuscular antitetanus serum, and intravenous infusion of Viper-FAB, an antidote. His vital signs normalized and he was admitted to intensive care for further observation.One hour after admission, the patient’s systolic blood pressure dropped to 40 mm Hg. Intravenous noradrenaline was started. Thirty minutes later, the patient lost consciousness in association with a rhythm change to torsade de pointes. He was defibrillated with 100 J (biphasic defibrillator) to sinus rhythm. Intravenous magnesium was started, and a repeat 12-lead ECG showed a prolonged corrected QT interval at 490 ms with no ST elevation (Figure 1). An urgent echocardiogram demonstrated normal-sized left ventricle with mild hypokinesis of the anterior wall and a global left ventricular fraction of 60%. Tissue Doppler images acquired by Vivid-7 (GE Medical) …