Acute ST-segment elevation myocardial infarction from a centipede bite

Abstract

Acute myocardial infarction (AMI) following a centipede bite has been very rarely reported. Here, we describe a 22 year-old man who had ST-segment elevation AMI after a centipede bite. He presented with typical chest pain, electro and echocardiographic abnormalities, and elevated cardiac enzymes with normal coronary angiography. The probable mechanisms were described. Practitioners treating centipede bites shall not consider it lightly, as centipede envenomation may produce a variety of systemic and local manifestations in susceptible individuals.

Problems and Paradoxes of Animal Toxins and the Heart

“…83À85 In some of them, coronary angiogram was entirely normal, which reveals the fact of coronary vasospasm. 85 Even though the exact pathophysiology in both cases was unidentified, the most probable mechanisms may be acute release of inflammatory mediators, inducing increased capillary permeability, inflammatory changes, hypotension, and coronary artery spasm; this may have led to acute myocardial infarction with raised cardiac biomarkers. 85 In these patients, bradycardia was noted despite hypotension.…”

“…85 Even though the exact pathophysiology in both cases was unidentified, the most probable mechanisms may be acute release of inflammatory mediators, inducing increased capillary permeability, inflammatory changes, hypotension, and coronary artery spasm; this may have led to acute myocardial infarction with raised cardiac biomarkers. 85 In these patients, bradycardia was noted despite hypotension. 83,85 Possible hypothesis for this clinical manifestation is a direct toxic effect on the conduction pathway or increased vagal response from the venom.…”

“…83,85 Possible hypothesis for this clinical manifestation is a direct toxic effect on the conduction pathway or increased vagal response from the venom. 85 …”

Centipede Envenomations: Clinical Effects and Treatment

“…The Scolopendra species venom contains toxin S, which in amphibian animal models has cardiotoxic effects. Several previously published case reports describe chest pain, acute ST segment elevation myocardial infarction (STEMI), and elevated levels of cardiac troponins in healthy young adults with no coronary risk factors (Yildiz et al 2006;Ozsarac et al 2004;Senthilkumaran et al 2011). In some of these intriguing case reports, cardiac catheterization studies were negative for atherosclerotic heart diseases, suggesting that the venom may cause coronary ischemia from a vasospastic mechanism.…”

“…He was noted to have normalized his wall motion on repeat echocardiography, done 3 days after his initial echocardiogram ( Fig. 23.5) (Senthilkumaran et al 2011). …”