Myocardial infarction after a viper bite: a case report

Introduction. Venomous snakes are a rare phenomenon in European Russia, and, nevertheless, bite cases are registered every year. This article presents a case of coronary thrombosis and myocardial infarction due to a bite of a venomous snake (Vipera berus) in a patient without prior coronary atherosclerosis.

Brief description. A 42-year-old patient was delivered to the emergency department of the vascular center by an ambulance team with typical anginal complaints after a bite of an unknown snake. The electrocardiogram showed ST segment elevation with corresponding reciprocal abnormalities. The patient was admitted to the X-ray operating room, where coronary artery thrombosis was detected without underlying atherosclerosis. Attempts at thrombus aspiration were ineffective and the intervention was stopped. Subsequently, the diagnosis of myocardial infarction was confirmed by paraclinical investigations. The patient’s condition remained stable, and conservative therapy complied with modern guidelines on myocardial infarction. The further course of the disease was uneventful. The patient was discharged in satisfactory condition on the 10th day of disease.

Discussion. This case is rare for Russia, but not the only one in world practice. The search query "myocardial infarction after snakebite", "myocardial infraction associated with snakebite" in the Pubmed database yields 24 case reports, most of which were described in endemic areas, mainly in Asia. The venom of some snakes has proven procoagulant activity, which is confirmed by individual studies and similar case reports. However, it is not possible to definitively rule out Kounis syndrome in these circumstances, which leaves the exact pathogenesis of coronary thrombosis after a snakebite open to discussion.

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