Snake Bite and Arrhythmia

Snake bites are an emergency condition that can result in mortality. There is a particularly high incidence of cases during the summer months. Hematological, pulmonary, cardiovascular, local findings, gastrointestinal, central nervous system symptoms and findings may be present. As previously outlined, the following parameters were meticulously monitored: auscultation of heart and lung sounds, follow-up with a bedside heart monitor, evaluation of clinical examination findings, evaluation of oedema level, vital signs, complete blood count (CBC), biochemical and coagulation tests. Numerous studies have documented the occurrence of arrhythmias following snake envenomation. Electrocardiograms (ECGs) in affected individuals often display nonspecific alterations, like sinus arrest with a junctional escape rhythm as well as retrograde P-waves at a heart rate of 40 beats per minute, indicating possible sinus node dysfunction. However, by third day of hospitalization, ECGs can return to normal sinus rhythm. Sinus tachycardia and bradycardia have been observed in envenomated patients. Additionally, T-wave inversion, as well as bradycardia is common ECG finding. Atrial fibrillation, frequently reported in these cases, may present with rapid ventricular rate of 126 beats per minute and typically resolves within 24hrs of antivenom administration. In certain patients, ECGs recorded 3hrs after the bite—despite the absence of initial cardiovascular symptoms-have indicated new-onset atrial fibrillation, which was effectively treated using amiodarone. This underscores the importance of extended cardiac monitoring, even beyond acute phase. Moreover, a pre-existing first-degree atrioventricular block (AVB) has been identified as a risk factor for developing atrial fibrillation in some individuals bitten by snakes [1].