Sudden cardiac arrest and cerebral thrombosis due to bites by Russell’s viper (Daboia siamensis)

Abstract Russell's viper bite is an important public health problem of tropical countries including Thailand. Common manifestations after Russell's viper bite are local tissue swelling, coagulopathy, and nephrotoxicity. Cardiac manifestation and cerebral infarction rarely occur. Herein, we reported two cases of cardiac arrest with evidence of large vessel complication following Russell's viper bite. The first case was a 52-year-old man who presented with cardiac arrest due to acute myocardial infarction. His coronary angiography result showed 95% stenosis of the mid left anterior descending artery and a drug-eluting stent was successfully placed. The second case was a 46-year-old female who developed cardiac arrest followed by an acute ischemic stroke. Antivenom was given and her symptom improved. We hypothesized that our patients developed a prothrombotic state associated with consumptive coagulopathy, causing large vessel thrombosis. The exact mechanism to explain these complications, however, is still inconclusive. Nonetheless, early recognition of these events and prompt treatment may reduce morbidity and mortality