Scorpion Sting-induced Pulmonary Edema (original) (raw)
Acute myocarditis and pulmonary edema due to scorpion sting
Global Cardiology Science and Practice, 2016
Objective: To present a case of a serious manifestation of scorpion sting, which was not reported before in Qatar, review the literature, and compare with previously reported similar cases. Case presentation and intervention: A young male patient was admitted to CCU with a clinical picture of acute toxic myocarditis and cardiogenic shock with abnormal ECG and elevated cardiac markers after a scorpion sting to his right big toe. Thorough investigations, including echocardiography, cardiac MRI and right heart catheterization, supported the diagnosis. Coronary angiography was normal. Patient was managed conservatively with supportive measures, mechanical ventilation, IV fluids, inotropic agents, steroids, antibiotics and Prazocin. Over 9 days of hospital course, patient gradually improved, was successfully extubated, and was discharged in a stable condition. Conclusion: Toxic myocarditis (with myocardial damage), pulmonary edema and cardiogenic shock are reported manifestations of scorpion venom intoxication.
Scorpion Bite Induced Myocardial Ischaemia and Pulmonary Edema
Journal of Case Reports, 2020
Background: Scorpion stings are common in India. Most of them are limited to moderate to severe pain at site of bite only, but good number of patients present with life threatening complications in the form of involvement of cardiac, respiratory and nervous system. Here we are reporting a case of myocarditis and pulmonary edema following sting of scorpion. Case Report: A 25 year old male presented with scorpion bite induced myocardial ischaemia, congestive cardiac failure and pulmonary edema. The cardiovascular manifestations in scorpion bite are the result of effect of venom on the sympathetic nervous system, adrenal secretion of catecholamines and the direct toxic effect of the venom on myocardium itself. Conclusion: Severe scorpion bites can present as myocardial ischaemia, congestive cardiac failure and pulmonary edema. Aggressive management with ventilator support, diuretics, parenteral steroids, antihistaminics and ionotropic agents can result in rapid clinical resolution.
International Journal of Cardiology, 2013
Scorpion envenomation is common in tropical and subtropical regions. Cardio-respiratory manifestations, mainly cardiogenic shock and pulmonary edema, are the leading causes of death after scorpion envenomation. The mechanism of pulmonary edema remains unclear and contradictory conclusions were published. However, most publications confirm that pulmonary edema has been attributed to acute left ventricular failure. Cardiac failure can result from massive release of catecholamines, myocardial damage induced by the venom or myocardial ischemia. Factors usually associated with the diagnosis of pulmonary edema were young age, tachypnea, agitation, sweating, or the presence of high plasma protein concentrations. Treatment of scorpion envenomation has two components: antivenom administration and supportive care. The latter mainly targets hemodynamic impairment and cardiogenic pulmonary edema. In Latin America, and India, the use of Prazosin is recommended for treatment of pulmonary edema because pulmonary edema is associated with arterial hypertension. However, in North Africa, scorpion leads to cardiac failure with systolic dysfunction with normal vascular resistance and dobutamine was recommended. Dobutamine infusion should be used as soon as we have enough evidence suggesting the presence of pulmonary edema, since it has been demonstrated that scorpion envenomation can result in pulmonary edema secondary to acute left ventricular failure. In severe cases, mechanical ventilation can be required.
Echocardiographic changes during acute pulmonary edema subsequent to scorpion sting
Acute pulmonary edema (APE) occurring after scorpion sting is the leading cause of death of the victims of scorpion envenomation. The APE origin is still questioned by physicians treating these patients. Based on echocardiographic study of 20 patients with severe envenomation treated in Ouargla Hospital resuscitation ward during the last four years, the APE etiology seems more likely cardiogenic, referring to cardiac symptoms confirmed by echocardiography although other mechanisms may also be involved. This hypothesis is further confirmed by the positive response of patients to the administration of dobutamine.
Indian Journal of Medical Sciences, 2006
Scorpion sting is a common problem in villages of Eastern Nepal. The life-threatening complications of myocarditis and pulmonary edema is known in red scorpion in India but not reported in Nepal. This condition requires urgent attention and ICU care from few hours to days. Delay in recognition and the hypoxemia increase the morbidity and mortality. Illiteracy, ignorance, poverty, traditional faith healers trying treatment in remote areas, lack of transport in difficult terrains and the non availability of ventilation facility in nearby hospital, add to delay in appropriate treatment. Seven young adult patients admitted in a span of two years with history of scorpion sting presenting with pulmonary edema required ICU care. They were successfully managed with the positive pressure ventilation with PEEP, cardiac support with inotropes and fluid balance. Magnitude of problem, clinical presentation and management done is emphasized.
Severe acute myocarditis due to scorpion envenoming: unusual presentation in adults
Journal of Cardiology & Current Research, 2020
A 21-year-old healthy woman presented to emergency department complaining of severe gluteus pain and progressive dyspnea about one hour after domestic accidental "black scorpion" sting. Despite early scorpion antivenom administration, advanced airway and intensive critical care were promptly required, due to refractory acute respiratory failure (ARF), endorsed by a critical PaO2/ FiO2 of 48. Chest computed tomography revealed diffuse bilateral infiltrates and air bronchograms compatible with acute respiratory distress syndrome. Cardiac troponin levels continuously rose. Initial transthoracic echocardiogram (TTE) revealed diffuse hypokinesia causing moderate left ventricle (LV) systolic dysfunction-rest LV ejection fraction (LVEF) of 0.39 (Simpson´s method) (Figure 1). Inotrope at low doses (dobutamine 5mcg/kg/min) was then initiated. Follow-up (ninth day) TTE (Figure 2) and cardiac magnetic resonance (CMR) imaging endorsed reversal of initial contractile dysfunction. At eleventh day patient was uneventfully discharged home.
Right Ventricular Dysfunction Following Severe Scorpion Envenomation
CHEST Journal, 1995
Evaluation of right ventricular (RV) performance in patients presenting with pulmonary edema following scorpion envenomation. Design: Cohort study. Setting: Medical intensive care unit of a teaching hospital. Patients: Eight consecutive adult patients stung by yellow scorpion Androctonus australis and presenting with pulmonary edema at hospital admission. Interventions: In all patients, standard hemodynamic parameters and RV volumes were measured using a pulmonary artery catheter equipped with a rapid responding thermistor enabling measurement of RV ejection fraction (RVEF). Measurements: Hemodynamic evaluation was performed at the time of hospital admission prior to any therapeutic intervention and just before the removal of the pulmonary catheter (2.3 ± 0.5 days after admission) in the surviving patients (n=7). Results: All patients had a decreased RVEF (24 ± 7%) and cardiac index (2.44 ± 0.5 Umin!m 2) and increased pulmonary artery occlusion pressure (23 ± 6 mm Hg). Right ventricular end-systolic pressure/volume ratio was decreased (.56 ± .19 mm HglmUm 2), suggesting an altered RV contractility. Follow-up evaluation performed in survivors, without any inotropic support, showed hemodynamic changes reflecting a trend toward full recovery. Right ventricular ejection fraction and cardiac index improved markedly (from 24 ± 7% to 39 ± 10% and from 2.44 ± 0.5 to 4 ± .3 Umin/m 2 , respectively). Pulmonary artery occlusion pressure, peak systolic pulmonary artery pressure, and mean pulmonary artery pressure decreased significantly from S cmpion envenomation represents a r eal public health problem in many countries; cardiovascular symptoms and pulmonary edema are the most frequent features in severely stung patients. 1 Pathologic and hemodynamic findings clearly point to left myocardial dysfunction as the cause of pulmonary edema. 2
BMJ case reports, 2013
The occurrence of an acute myocardial infarction (MI) following a scorpion sting has been very rarely reported in the previous literature. Possible pathogenetic mechanisms include severe hypotension due to hypovolaemic shock and coronary spasm with subsequent thrombosis of coronary vessels developed after the release of vasoactive, inflammatory and thrombogenic substances contained in the scorpion venom. All of the previously reported cases had normal coronary angiogram. We report a case of a 65-year-old woman who presented with severe scorpion sting and was treated with prazosin. But a few hours later, she developed acute anterior wall MI. Coronary angiogram revealed the presence of significant stenosis in coronary arteries. As acute MI owing to significant coronary artery disease can be evident after severe scorpion envenomation, so every case of acute coronary syndrome following scorpion sting needs early diagnosis, thorough cardiovascular evaluation and appropriate treatment.
Uncommon Presentation of Scorpion Envenomation: A Case Report
International Journal of Contemporary Medical Research [IJCMR]
Introduction: Scorpion bites are common in India, particularly in the rural areas. The etiology of the cardiovascular manifestations in severe scorpion sting is related to the venom effects on the sympathetic nervous system and the adrenal secretion of catecholamines as well as to the toxic effects of the venom on the myocardium. Case report: Here we are reporting a case of 45 years male patient with scorpion bite presented with chest pain and perspiration. Patient was treated aggressively with Non Invasive ventilation (NIV), anticoagulation, dual antiplatelets, statins and alpha blocker (Prazocin). Conclusion: Cardiac manifestations like myocarditis, pulmonary oedema and cardiologic shock after scorpion envenomation was observed and can