Skip to main content
SpringerLink
Log in

Evidence of myocardial ischaemia in severe scorpion envenomation

Myocardial perfusion scintigraphy study

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

To explore the myocardial perfusion by thallium-201 scintigraphy for patients with evidence of myocardial damage after scorpion envenomation.

Design

Prospective study over 1-year period.

Setting

Medical intensive care unit of a university hospital (Sfax, Tunisia).

Patients

We have prospectively included six patients admitted for scorpion envenomation over a period of 1 year in the 22-bed intensive care unit (ICU) of our university hospital. The evidence of myocardial damage was confirmed by electrocardiography and echocardiography in all patients. Myocardial perfusion scintigraphy (201Tl scintigraphy) coupled with radionuclide ventriculography (99mTc) was performed for all patients, occurring 32 h on average (range 12–72 h) after the sting.

Results

Radionuclide ventriculography was abnormal in all cases; the abnormalities observed were similar to those observed by echocardiography. Moreover 201Tl scintigraphy showed evidence of myocardial hypoperfusion in all cases. The myocardial hypoperfusion grade and localisation were more marked in the abnormal localisation shown by echocardiography and electrocardiography, compared to the normal wall. Repeated studies, obtained only in two patients within 6 and 15 days, respectively, showed considerable, but not complete, improvement of wall motion and myocardial perfusion. Segments with improved perfusion showed greatly improved regional wall motion.

Conclusion

This study confirms the evidence of myocardial hypoperfusion after severe scorpion envenomation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bahloul M, Bouaziz M, Dammak H, Ben Hamida C, Ksibi H, Rekik N, Chelly H, Teboul JL, Kallel H (2002) Value of the plasma protein and hemoglobin concentration in the diagnosis of pulmonary edema in scorpion sting patients. Intensive Care Med 28:1600–1605

    Article  Google Scholar 

  2. Abroug F, Ayari M, Nouira S, Gamra H, Boujdaria R, Elatrous S, Ben Farhat M, Bouchoucha S (1995) Assessment of left ventricular function in severe scorpion envenomation: combined hemodynamic and echo-Doppler study. Intensive Care Med 2:629–635

    Google Scholar 

  3. Gueron M, Weizmann S (1969) Catecholamine excretion in scorpion sting. Isr J Med Sci 5:855–857

    CAS  PubMed  Google Scholar 

  4. R Yarom, K Braun (1971) Electron microscopic studies of the myocardial changes produced by scorpion venom. Lab Invest 24:21–30

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  7. Sansoy V, Glover DK, Watson DD, Ruiz M, Smith WH, Simanis JP, Beller GA(1995) Comparison of thallium-201 resting redistribution with technetium-99m—sestamibi uptake and functional response to dobutamine for assessment of myocardial viability. Circulation 92:994–1004

    CAS  PubMed  Google Scholar 

  8. Gibson RS, Watson DD, Craddock GB, Crampton RS, Kaiser DL, Denny MJ, Beller GA (1983) Prediction of cardiac events after uncomplicated myocardial infarction: a prospective study comparing predischarge exercise thallium-201 scintigraphy and coronary angiography. Circulation 2:321–336

    Google Scholar 

  9. Brown KA (1991) Prognostic value of thallium-201 myocardial perfusion imagining. A diagnostic tool comes of age. Circulation 83:363–381

    CAS  PubMed  Google Scholar 

  10. Green MV, Brody WR, Douglas MA, Borer JS, Ostrow HG, Line BR, Bacharach SL, Johnston GS (1978) Ejection fraction by count rate from gated images. J Nucl Med 19 (8):880–883

    CAS  PubMed  Google Scholar 

  11. Elatrous S, Nouira S, Besbes-Ouanes L, Boussarsar M, Boukef R, Marghli S, Abroug F (1999) Dobutamine in severe scorpion envenomation: effects on standard hemodynamics, right ventricular performance and tissue oxygenation. Chest 116:748–753

    CAS  PubMed  Google Scholar 

  12. Meki AR, Mohamed ZM, Mohey El-deen HM (2003) Significance of assessment of serum cardiac troponin I and interleukin-8 in scorpion envenomed children. Toxicon 41:129–137

    Article  CAS  PubMed  Google Scholar 

  13. Wang R, Moreau P, Deschamps A, de Champlain J, Sauve R, Foucart S, Bai L, Lu XR (1994) Cardiovascular effects of Buthus martensii (Karsch) scorpion venom. Toxicon 32:191–200

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  16. Margulis G, Sofer S, Zalstein E, Zucker N, Ilia R, Gueron M (1994) Abnormal coronary perfusion in experimental scorpion envenomation. Toxicon 32:1675–1678

    Article  CAS  PubMed  Google Scholar 

  17. Sofer S, Shahak E, Slonim A, Gueron M (1991) Myocardial injury without heart failure following envenomation by the scorpion leirus quinquestriatus in children. Toxicon 29:382–385

    Article  CAS  PubMed  Google Scholar 

  18. Ismail M, Osman O H, Petkovic D (1976) Electrocardiographic studies with scorpion ( Buthus Minax, L. Koch) venom. Toxicon 14:79–83

    Article  CAS  PubMed  Google Scholar 

  19. Silveira NP, Moraes-Santos T, Azevedo AD, Freire-Maia L (1991) Effects of Tityus serrulatus scorpion venom and one of its purified toxins (toxin gamma) on the isolated guinea-pig heart. Comp Biochem Physiol C 98:329–336

    Article  CAS  PubMed  Google Scholar 

  20. Pezard P, Jallet P(1998) Myocardial viability. Study of viability by myocardial scintigraphy. Presse Med 27:1043–1049

    CAS  PubMed  Google Scholar 

  21. Simons M, Downing SE (1985) Coronary vasoconstriction and catecholamine cardiomyopathy. Am Heart J 109:297–304

    CAS  PubMed  Google Scholar 

  22. Fukuhara YD, Reis ML, Dellalibera-Joviliano R, Cunha FQ, Donadi EA (2003) Increased plasma levels of IL-1beta, IL-6, IL-8, IL-10 and TNF-alpha in patients moderately or severely envenomed by Tityus serrulatus scorpion sting. Toxicon 41:49–55

    Article  CAS  PubMed  Google Scholar 

  23. Klemm P, Warner TD, Hohlfeld T, Corder R, Vane JR (1995) Endothelin 1 mediates ex vivo coronary vasoconstriction caused by exogenous and endogenous cytokines. Proc Natl Acad Sci U S A 92:2691–2695

    CAS  PubMed  Google Scholar 

  24. Kadokami T, Shimokawa H, Fukumoto Y, Ito A, Takayanagi T, Egashira K, Takeshita A (1996) Coronary artery spasm does not depend on the intracellular calcium store but is substantially mediated by the protein kinase C-mediated pathway in a swine model with interleukin-1 beta in vivo. Circulation 94:190–196

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service de Réanimation médicale, CHU Habib Bourguiba, Route el Ain Km 1, 3029, Sfax, Tunisia

    Mabrouk Bahloul, Chokri Ben Hamida, Hichem Ksibi, Hassen Dammak, Hatem Kallel, Hedi Chelly & Mounir Bouaziz

  2. Service de médicine nucléaire, CHU Habib Bourguiba, Route el Ain Km 1, 3029, Sfax, Tunisia

    Khalil Chtourou & Fadhel Guermazi

  3. SAMU de Sfax, CHU Habib Bourguiba, Route el Ain Km 1, 3029, Sfax, Tunisia

    Adel Chaari & Noureddine Rekik

Authors
  1. Mabrouk Bahloul
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chokri Ben Hamida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Khalil Chtourou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hichem Ksibi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hassen Dammak
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hatem Kallel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Adel Chaari
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hedi Chelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Fadhel Guermazi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Noureddine Rekik
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mounir Bouaziz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mounir Bouaziz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bahloul, M., Ben Hamida, C., Chtourou, K. et al. Evidence of myocardial ischaemia in severe scorpion envenomation. Intensive Care Med 30, 461–467 (2004). https://doi.org/10.1007/s00134-003-2082-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-003-2082-7

Keywords

Search

Navigation