Department of Emergency Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia.
Clin Toxicol (Phila). 2012 Jul;50(6):518-21. doi: 10.3109/15563650.2012.696119. Epub 2012 Jun 18.
Envenoming by some species of cobras (Naja species) may include cardiotoxic effects including various dysrhythmias. However, dysrhythmias leading specifically to ventricular bigeminy have not been previously documented. We report a case of cardiotoxicity and the development of ventricular bigeminy following a cobra envenomation.
The patient was a 23-year-old man who presented to an emergency department following an alleged cobra bite. There was transient episode of nausea, vomiting, hypotension and tachycardia. The ECG showed infrequent ventricular ectopics that progressed to ventricular bigeminy and persisted even after the vital signs normalized. Complete resolution and resumption of normal sinus rhythm occurred following an empirical administration of monovalent antivenom against Naja kaouthia venom. The patient was discharged after 24 hours of uneventful observation.
The patient's concomitant local effects, episodic cardiovascular instability and evolution of ventricular bigeminy support the likelihood of a venom-induced disease. Ventricular bigeminy can develop following a cobra envenomation. Thorough clinical evaluation, close serial observation of vital signs and early continuous cardiac monitoring are important in Naja spp. bites.
某些眼镜蛇（眼镜蛇属）的毒液可能会导致心脏毒性作用，包括各种心律失常。然而，以前没有记录过专门导致室性二联律的心律失常。我们报告了一例眼镜蛇咬伤后发生的心脏毒性和室性二联律的病例。
患者为 23 岁男性，被疑似眼镜蛇咬伤后就诊于急诊科。患者出现一过性恶心、呕吐、低血压和心动过速。心电图显示偶发室性早搏，进展为室性二联律，即使生命体征恢复正常后仍持续存在。在给予单价抗眼镜蛇毒液（针对 Naja kaouthia 毒液）的经验性治疗后，完全缓解并恢复正常窦性节律。患者在观察 24 小时后无症状出院。
患者的局部症状并存、间歇性心血管不稳定和室性二联律的发展支持毒液引起的疾病的可能性。室性二联律可在眼镜蛇咬伤后发生。在眼镜蛇属咬伤中，全面的临床评估、密切的生命体征连续观察和早期连续心脏监测非常重要。
