Author(s): Farshid Etaee , Aaron B. Hesselson
Copperhead (Agkistrodon contortrix) snakes are responsible for approxi-
mately 40% of all pit viper envenomations in the US.
Case presentation:
: A 14-year-old girl was bitten by a copperhead snake bite. Electro-
cardiogram 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 complica-
tions 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