Case Report
Published November 11, 2019
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Bradycardia, snake bite

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Etaee, F., & Hesselson, A. (2019). A Patient with Severe Bradycardia Five Years After Copperhead Snake Bite. Internal Medicine and Medical Investigation Journal, 4(3).

A Patient with Severe Bradycardia Five Years After Copperhead Snake Bite: Bradycardia with Snake Bite

Farshid Etaee
University of Texas Southwestern Medical Center, Internal Medicine
Aaron Hesselson
University of Kentucky

Introduction: Copperhead (Agkistrodon contortrix) snakes are responsible for approximately 40% of all US pit viper envenomations. Case Presentation: A 14-year-old girl experienced a copperhead snake bite. ECG approximately one hour after envenomation showed her to be in sinus rhythm with no acute ST or T wave changes. She was not given anti-venom, but was monitored, treated with antibiotics and discharged without any significant complications after 2 days time. Approximately 5 years after the incident she began having issues of refractory constipation. Subsequently, she also had numerous episodes of recumbent and ambulatory syncope outside of any acute GI distress, and occurring without warning. A dual-chamber pacemaker (Medtronic™) was inserted for which “rate-drop” response was programmed on. Conclusion: Delayed sequelae from a copperhead snakebite appears possible given our patient’s presentation. The mechanism of delayed autonomic dysfunction +/- possible direct cardiac effect, however, remains unclear.
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