Cardiovascular Disease Events in Hemotoxic Snakebite Envenoming: A Prospective Observational Study from Himachal Pradesh, India

Akshit Gupta.1 Sujeet Raina.3 Bikram Shah.2 Manoj Thakur.2 Nikhil Kumar.1

.1Postgraduate student, Department of Internal Medicine, Dr. RPGMC, Tanda, Kangra 

.2Assistant Professor, Department of Internal Medicine, Dr. RPGMC, Tanda, Kangra 

.3Professor, Department of Internal Medicine, Dr. RPGMC, Tanda, Kangra

Correspondence: Sujeet Raina, Department of Internal Medicine, C-15, Type-V Quarters, Dr RPGMC Campus Tanda, Kangra (H.P.) India.

Received: December 23, 2025                                         Published: March 20,2026

Citation: Sujeet Raina, Cardiovascular Disease Events in Hemotoxic Snakebite Envenoming: A Prospective Observational Study from Himachal Pradesh, India. AOJ Emerg and Int Med. 2026;1(3):68–78.

Copyright: ©2026 Sujeet Raina. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially.

Abstract 

Background: Cardiotoxicity as a feature of snake bite envenomation toxidrome is uncommonly described. The study was conducted to assess the prevalence of cardiovascular disease events in patients with hemotoxic venomous snakebites. 

Material and Methods: This was a hospital based open cohort observational study conducted on patients diagnosed with hemotoxic envenoming. The study period was of one year using a nonprobability sampling method. Hemotoxic envenoming was defined as positive bedside 20 min whole blood clotting time (20 WBCT) following a history of snake bite. Cardiovascular events were recorded based on clinical history and examination, electrocardiography, high sensitivity (HS) troponin I levels and echocardiogram. Time frames to understand the sequential changes during the hospital stay were defined as less than 48 h, 48 to 96 hours, and at discharge. 

Results: A total of 62 patients were included in the study. The prevalence of cardiovascular disease events was 16.1% (10/62). ECG changes were observed in nine patients. Three patients developed acute coronary syndrome, One patient had features of capillary leak syndrome. presented with shock and required inotropes. 

Conclusion: The study demonstrated that cardiovascular disease events are not an uncommon entity due to hemotoxic snakebite envenoming in the geographical region of Himachal Pradesh, India. 

Keywords: Cardiac, heart, myocardial infarction, snakes

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