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Assessment of left ventricular function in severe scorpion envenomation: Combined hemodynamic and echo-Doppler study

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Abstract

Objective

To assess left ventricular function in patients presenting with pulmonary edema following scorpion envenomation.

Design

Cohort study.Setting: Medical intensive care unit of a teaching hospital.Patients: Nine consecutive adult patients stung byAndroctonus australis and presenting with pulmonary edema entered the study. Fourteen normal volunteers comprised the control group.

Interventions

Upon admission, all patients had right heart catheterization and, within the first 8 h, a Doppler echocardiographic study. Results of Doppler echocardiographic studies were compared to those of controls.

Measurements and results

Usual hemodynamic information (heart and vascular pressures, derived data and tissue oxygenation parameters), left ventricular dimensions and indicators of systolic function, and Doppler-derived parameters of left ventricular filling and diastolic function were obtained upon admission. Serial echocardiographic measurements were repeated daily until full clinical recovery (eight patients) or death (one patient). All patients had a hemodynamic profile of acute congestive heart failure (mean PAOP=24±2 mmHg; mean SVI=22±7 ml/m2; mean CI=2.5±0.5 l/min/m2). However, SVR were not increased (mean=22±3 U/m2). Left ventricle was hypokinetic in all patients with transient mitral regurgitation present in five patients. Left ventricular systolic function was markedly depressed (FS=12±6%; EF=26±12%). An associated diastolic dysfunction is suggested by Doppler records of mitral inflow. Left ventricular systolic function evolved toward normalization within 6±2 days preceded by full clinical recovery.

Conclusions

These data suggest that pulmonary edema in scorpion envenomation is of hemodynamic origin and is related to a severe and prominent impairment of left ventricular systolic function.

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References

  1. Gueron M, Yaron R (1970) Cardiovascular manifestations of severe scorption sting. Clinicopathologic correlations. Chest 57:156–162

    Google Scholar 

  2. Gueron M, Ilia R, Sofer S (1992) The cardiovascular system after scorpion envenomation. A review. Clin Toxicol 30:245–258

    Google Scholar 

  3. Abroug F, Boujdaria R, Belghith M, Nouira S, Bouchoucha S (1991) Cardiac dysfunction and pulmonary edema following scorpion envenomation. Chest 100:1057–1059

    Google Scholar 

  4. Tarasiuk A, Sofer S, Huberfelo S, Scharf M (1994) Hemodynamic effects following injection of venom from the scorpionLeirus quinquestriatus. J Crit Care 9:134–140

    Google Scholar 

  5. Gueron M, Adolph RJ, Grupp IL, Gabel M, Grupp G, Fowler NO (1980) Hemodynamic and myocardial consequences of scorpion venom. Am J Cardiol 45:979–986

    Google Scholar 

  6. Ismail M, Ghazal A, El Fakahani EE (1980) Cardiovascular effects of venom from the scorpionButhus occiotanus amoreux. Toxicon 18:327–337

    Google Scholar 

  7. Yarom R, Braun K (1970) Cardiovascular effects of scorpion venom: morphological changes in the myocardium. Toxicology 8:41–46

    Google Scholar 

  8. Rahav G, Weiss AT (1990) Scorption-sting-induced pulmonary edema: scintigraphic evidence of cardiac dysfunction. Chest 97:1478–1480

    Google Scholar 

  9. Amaral CFS, De Rezendo NA, Freire-Maia L (1993) Acute pulmonary edema afterTityus serrulatus scorpion sting in children. Am J Cardiol 71:242–245

    Google Scholar 

  10. Amaral CFS, Lopes JA, Magalhares RA, De Rezendo NA (1991) Electrocardiographic, enzymatic and echocardiographic evidence of myocardial damage afterTityus serrulatus scorpion poisoning. Am J Cardiol 67: 655–657

    Google Scholar 

  11. Gueron M, Margulis G, Sofer S (1990) Echocardiographic and radionuclide angiographic observations following scorpion envenomation byLeirus quinquestriatus. Toxicon 28:1005–1009

    Google Scholar 

  12. Hering SE, Jurca M, Vichi FL, Azevdo-Marques HM, Cupo P (1993) Reversible cardiomypathy in patients with severe scorpion envenoming byTityus serrulatus: evolution of enzymatic, electrocardiographic and echocardiographic alterations. Ann Trop Pediatr 13:173–182

    Google Scholar 

  13. Kumar EB, Soomro RS, Al Hamdani A, El Shimy N (1992) Scorpion venom cardiomyopathy. Am Heart J 123: 725–729

    Google Scholar 

  14. Teichholz LE, Kreulen T, Herman MY, Gorlin R (1976) Problems in echographic volume determinations: echocardiographic-angiographic volume correlations in the presence or absence of asynergy. Am J Cardiol 37:711

    Google Scholar 

  15. Gueron M, Stern J, Cohen W (1967) Severe myocardial damage and heart failure in scorpion sting. Report of five cases. Am J Cardiol 19:719–726

    Google Scholar 

  16. Poon-King T (1963) Myocarditis from scorpion stings. BMJ 1:374–377

    Google Scholar 

  17. Appleton CP, Hatle LK, Popp RL (1988) Relation of transmitral velocity patterns to left ventricular diastolic function: new insights from combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol 12:426–440

    Google Scholar 

  18. Quinones MA (1993) Doppler assessment of left ventricular diastolic function. In: Nanda CN (ed) Doppler echocardiography, 2nd edn. Lea and Febiger, Philadelphia, pp 197–215

    Google Scholar 

  19. Nishimura RA, Abel MD, Hatle LK, Tajik AJ (1989) Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography. Part 2. Clinical studies. Mayo Clin Proc 64:181–204

    Google Scholar 

  20. Rossvol O, Hatle LK (1993) Pulmonary venous flow velocities recorded by transthoracic Doppler ultrasound: relation to left ventricular diastolic pressures. J Am Coll Cardiol 21:1687–1696

    Google Scholar 

  21. Brand A, Keren A, Kerem E, Reifen RM, Branski D (1988) Myocardial damage after a scorpion sting: longterm echocardiographic follow-up. Pediatr Cardiol 9:59–61

    Google Scholar 

  22. Sofer S, Gueron M (1990) Vasodilators and hypertensive encephalopathy following scorpion envenomation in children. Chest 97:118–120

    Google Scholar 

  23. Bawaskar HS, Bawaskar PH (1987) Prazosin for vasodilator treatment of acute pulmonary oedema due to scorpion sting. Ann Tropical Med Parasitol 81:719–723

    Google Scholar 

  24. Gueron M, Ilia R, Shahak E, Sofer S (1992) Renin and aldosterone levels and hypertension following envenomation in humans by the yellow scorpionLeirus quinquestriatus. Toxicon 30:765–767

    Google Scholar 

  25. Sofer S, Gueron M (1988) Respiratory failure in children following envenomation by the scorptionLeirus quinquestriatus. Hemodynamic and neurological aspects. Toxicon 26:931–939

    Google Scholar 

  26. Bawaskar HS, Bawaskar PH (1992) Management of the cardiovascular manifestations of poisoning by the indian red scorption (Mesobuthus tamalus). Br Heart J 68:478–480

    Google Scholar 

  27. Gueron M, Sofer S (1990) Vasodilators and calcium blocking agents in treatment of cardiovascular manifestations of human scorpion envenomation. Toxicon 28:127–128

    Google Scholar 

  28. Gueron M, Ovsyshcher I (1987) What is the treatment for the cardiovascular manifestations of scorpion envenomation? Toxicon 25:121–124

    Google Scholar 

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Authors and Affiliations

  1. Service de Réanimation Polyvalente, CHU F. Bourguiba, TN-5019, Monastir, Tunisia

    F. Abroug, S. Nouira, R. Boujdaria, S. Elatrous & S. Bouchoucha

  2. Department of Cardiology, CHU F. Bourguiba, TN-5019, Monastir, Tunisia

    M. Ayari, H. Gamra & M. Ben Farhat

Authors
  1. F. Abroug
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  2. M. Ayari
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  3. S. Nouira
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  4. H. Gamra
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  5. R. Boujdaria
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  6. S. Elatrous
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  7. M. Ben Farhat
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  8. S. Bouchoucha
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Abroug, F., Ayari, M., Nouira, S. et al. Assessment of left ventricular function in severe scorpion envenomation: Combined hemodynamic and echo-Doppler study. Intensive Care Med 21, 629–635 (1995). https://doi.org/10.1007/BF01711539

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  • DOI: https://doi.org/10.1007/BF01711539

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