Wanninayake W M D A S, Aponso Tilan, Seneviratne Manohari, Dissanayake Dhanapala
Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.
Trop Med Health. 2025 Jan 6;53(1):2. doi: 10.1186/s41182-024-00645-w.
Hump-nosed viper (Hypnale species) bites are an important cause of mortality and morbidity in southern India and Sri Lanka, accounting for 27 and 77% of venomous snake bites, respectively. Previously, we knew them to be moderately venomous snakes, primarily causing local envenomation. However, recent reports have indicated severe systemic envenomation incidents, which include hemostatic dysfunction, microangiopathic hemolysis, kidney injury, myocardial toxicity, and even death. The literature rarely reports cardiac manifestations from hump-nosed viper bites, and all reported cases show cardiac manifestations within hours of the snake bite. The literature did not report late presentations of cardiac manifestations. Here, we report a case of hump-nosed viper bite complicated with type 2 myocardial infarction and acute pulmonary oedema secondary to acute heart failure in a Sri Lankan female presented to the National Hospital of Colombo, Sri Lanka, on day 3 after the snake bite.
A local hospital transferred a previously healthy 39-year-old female from Kegalle, Sri Lanka, to our hospital for further condition management. We identified the offending snake as a hump-nosed viper after she reported a history of snake bites 3 days ago. She complained of chest tightness on day 3 of the illness and was found to have acute heart failure precipitated by troponin-positive non-ST elevation myocardial infarction in initial investigations. We performed a CT coronary angiography along with a metabolic screening, revealing normal coronary arteries and a negative metabolic screening. Supportive therapy with loop diuretics and oxygen managed her condition, and a follow-up 2D echocardiogram revealed complete recovery of her cardiac function. She was asymptomatic 3 months into the follow-up. Therefore, we concluded that the case was a venom-induced type 2 myocardial infarction leading to heart failure with acute pulmonary oedema, as the CT coronary angiogram showed normal coronary arteries.
尖吻蝮（Hypnale属）咬伤是印度南部和斯里兰卡死亡率和发病率的重要原因，分别占毒蛇咬伤的27%和77%。以前，我们认为它们是中度毒蛇，主要引起局部中毒。然而，最近的报告显示了严重的全身中毒事件，包括止血功能障碍、微血管病性溶血、肾损伤、心肌毒性，甚至死亡。文献中很少报道尖吻蝮咬伤后的心脏表现，且所有报道的病例在蛇咬伤后数小时内出现心脏表现。文献中未报道心脏表现的延迟出现。在此，我们报告一例尖吻蝮咬伤病例，该病例为一名斯里兰卡女性，在蛇咬伤后第3天被送往斯里兰卡科伦坡国立医院，并发2型心肌梗死和继发于急性心力衰竭的急性肺水肿。
一家当地医院将一名此前健康的39岁斯里兰卡凯格勒女性转诊至我院进行进一步病情管理。在她报告3天前有蛇咬史后，我们确定致伤蛇为尖吻蝮。她在患病第3天抱怨胸闷，初步检查发现由肌钙蛋白阳性的非ST段抬高型心肌梗死引发急性心力衰竭。我们进行了CT冠状动脉造影及代谢筛查，结果显示冠状动脉正常且代谢筛查为阴性。使用袢利尿剂和氧气进行支持治疗控制了她的病情，随访二维超声心动图显示其心脏功能完全恢复。随访3个月时她无症状。因此，由于CT冠状动脉造影显示冠状动脉正常，我们得出结论，该病例为毒液诱导的2型心肌梗死导致心力衰竭并伴有急性肺水肿。
