Senthilkumaran Subramanian, Meenakshisundaram Ramachandran, Thirumalaikolundusubramanian Ponniah
Sri Gokulam Hospitals & Research Institute, Salem, Tamil Nadu, India.
J Emerg Med. 2012 Mar;42(3):288-90. doi: 10.1016/j.jemermed.2010.11.052. Epub 2011 Apr 2.
Coagulopathy after snake bite is well known; however, cardiac tamponade as a manifestation of coagulopathy is rare.
To report a case of pericardial hemorrhage with cardiac tamponade after Russell viper bite.
A 26-year-old man developed breathlessness after being bitten by a Russell viper. The clinical and laboratory follow-up of this case confirmed the clinical diagnosis of toxin-induced disseminated intravascular coagulation. Interestingly, pericardial hemorrhage with large pericardial effusion was evident clinically as well as on electrocardiogram and echocardiogram, as an initial presentation without any other bleeding manifestations. The patient developed cardiac arrest and was revived with cardiopulmonary resuscitation. Emergency pericardiocentesis was carried out. He was given fresh frozen plasma in addition to snake antivenin along with symptomatic management. On the third day of hospitalization, the patient's clinical and laboratory profile returned to normal and he was discharged on the fifth day.
Pericardial hemorrhage may be due to toxin-induced myocardial damage or pericardial vessel injury coupled with coagulopathy, possibly in conjunction with vasculitis or endothelial damage. Practitioners and physicians should suspect and search for pericardial effusion in snake bite victims who develop breathlessness, and treat it vigorously in addition to antivenin therapy.
