A Title: A Patient with Severe Bradycardia Five Years After Copperhead Snake Bite: Bradycardia with Snake Bite
Introduction: Copperhead (Agkistrodon contortrix) snakes are responsible for approximately 40% of all pit viper envenomations in the US.
Case Presentation: A 14-year-old girl was bitten by a copperhead snake bite. Electrocardiogram taken approximately one hour after envenomation showed sinus rhythm with no acute ST or T wave changes. She was not administered 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 suffered from numerous episodes of recumbent and ambulatory syncope outside of any acute gastrointestinal distress and occurring without warning. A dual-chamber pacemaker (Medtronic™), programmed for “rate-drop” response, was inserted in the patient.
Conclusion: Delayed sequelae from a copperhead snakebite appears to be possible given our patient’s presentation. However, the mechanism of delayed autonomic dysfunction and/or possible direct cardiac effect remains unclear.
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