Systematic Reviews
Copyright ©The Author(s) 2023.
World J Cardiol. Jan 26, 2023; 15(1): 33-44
Published online Jan 26, 2023. doi: 10.4330/wjc.v15.i1.33
Table 1 Baseline demographic characteristics and presenting features of study participants demographic characteristics of study participants
Ref.
Year of publication
Country
Age
Gender
Comorbidity
Clinical presentation
Bee
Mishra et al[8]2016USA63FUnknownRash, diaphoresis, chest pain, dyspnea
Aono et al[9]2019Japan87FUnknownMultiple bee stings with multi-organ failure
Seecheran et al[10]2021Caribbean48FNoneObtunded, somnolent
Winogradow et al[12]2011Germany37FUnknownLocal itching, spreading hives
Winogradow et al[12]2011Germany70FUnknownSwelling of throat, chest pain
Ghanim et al[11]2015Israel37FNoneRash, dyspnea, impaired consciousness
Wasp
Scheiba et al[13]2011Germany81MUnknownAbsent pulses, gasping, unconsciousness
Geppert et al[14]2010Germany70FUnknownChest pain and dyspnoea
Spider
Alexakis et al[16]2015Greece64FHyperthyroidismNausea, tremor, infraorbital edema, diffuse abdominal pain, lower extremity muscle cramps
Isbister et al[17]2015Australia33MUnknownPerioral paresthesia, widespread fasciculation, diaphoresis, hypersalivation, dyspnea
Isbister et al[17]2015Australia13FUnknownLocalized intense pain, urinary incontinence, profuse sweating, and vomiting
Snake
Van Rensburg et al[18]2015South Africa58MNoneBilateral ptosis
Murase et al[19]2012Japan56FUnknownSwelling of left foot
Delumgahawaththa et al[40]2021Sri Lanka66FHypertension, hyperlipidemiaCentral chest pain
Scorpion
Abroug et al[29]2018Tunisia36FUnknownPulmonary edema, shock
Abroug et al[29]2017Tunisia45FUnknownAltered level of consciousness, respiratory failure, shock
Miranda et al[23]2015Brazil7MUnknownLocalized pain, vomiting, profuse sweating, dyspnea
Jain et al[27]2006India35MUnknownMild local pain, irritation
Jellyfish
Bianchi et al[24]2011Italy53FUnknownChest pain, fatigue, localized intense itch
Tiong et al[25]2009Australia26MUnknownLocalized pain, restlessness, agitation, palpitations
Table 2 Details of diagnosis, treatment, and outcome in study participants
Ref.
Agent
Mayo criteria
Type
Mechanism
Rx
Outcome
Mishra et al[8]BeeApical hypokinesia, LVEF – 40 to 45%; Absence of CAD; ST elevation, T wave inversion Troponin elevationApical-Cytotoxic storm; -Direct cardiotoxic effects of bee venom; -Anaphylactic reaction-ACEI; -BBImproved
Aono et al[9]Bees (Multiple)Apical hypokinesia; Absence of CAD; ST elevation in I, II, aVl, aVf, V2 to V6 and raised TroponinApical-Multi organ failure; -Death by cardiac rupture
Seecheran et al[10]African BeeApical hypokinesia; Absence of CAD; ST elevation in V1, V2, V3, raised TroponinApical-Cytokine storm; -Anaphylaxis-ARNI; -Eplerenone; -Bisoprolol; -DapagliflozinImproved
Winogradow et al[12]BeeAnterior, lateral, and Posterior hypokinesia; Absence of CAD; ST elevation in VI and raised TroponinReverse--BB; -ACEI; -Aldosterone agonist-
Winogradow et al[12]BeeApical wall hypokinesia; Absence CAD; VFIBApical-Hypersensitivity; -Epinephrine Injection--
Ghanim et al[11]BeesBasal and Mid hypokinesia; Absence of CAD; ST elevation in lateral leads and depression in anterior and inferior leads and raised TroponinReverse-Catecholamine storm; -Epinephrine injection-IABP; -VAECMO; -Adrenaline; -Norepinephrine and DopamineImproved
Scheiba et al[13]WaspApical and anteroseptal hypokinesia, LVEF – 45%; Absence of CAD; ST elevation in I, aVL, V2-V4 and Troponin elevationApical-Hypersensitivity; -Epinephrine Injection-BB; -ACEI; -AspirinImproved
Geppert et al[14]WaspApical (anterior and inferior) and anteroseptal hypokinesia (46%); Absence of CAD; ST segment elevations in the leads, V1–V3, T-negatives in leads I, aVL and V2 –V4 and raised TroponinApical-Epinephrine injection-Bisoprolol; -Ramipril; -AspirinImproved
Alexakis et al[16]Black widow spiderHypokinesis of the basal and middle segments of the LV wall with apical sparing, LVEF – 36%; CAG not done; T wave flattening in aVL, and Troponin elevationReverse-Alpha-ladrotoxin mediated catecholamine storm; -Cytokine storm- BB; -ACEI; -Aspirin; -ClopidogrelImproved
Isbister et al[17]Funnel web spiderDiffuse global hypokinesia with LVEF of 20%; CAG not done; Diffuse ST changes and troponin elevation--Toxin; -Antivenom; -Catecholamine stormImproved
Isbister et al[17]Funnel web spiderReduced EF- 45%; CAG not done; ST depression in the inferior and anterior leads and elevated troponin--Toxin; -Antivenom; -Adrenaline-Improved
Van Rensburg et al[18]Cape CobraMid and apical LV segment hypo or akinetic, LVEF: 27%, Absent CAD; New ST elevation across anterolateral leads, subsequent EKG showing T wave inversions in anterolateral leads, raised troponinMid ventricular and apical; (Apical ballooning)-Catecholamine storm; -Cytokine storm; -Catecholamine; release associated with Intensive Care Unit medicationSupportive care; Anti-snake venom administered for snake biteRecovery of RWMA within a week (ECHO)
Murase et al[19]Gloydius blomhoffii Snake (Mamushi)Abnormal LV systolic function, apical akinesis, hyperdynamic basal segment of LV; No stenotic lesions noted on the CT scan; EKG changes T inversions in 1, a VL, V1-6, raised troponinApical-UnknownSupportive management; No Anti snake venomComplete recovery (ECHO); (4 d)
Delumgahawaththa et al[40]Unidentified (Possibly Russel Viper)Hypokinetic mid and apex of LV segments, with ballooning, LVEF: 35%; Absence of CAD; EKG changes with ST elevation in 1 and a VL, T wave inversion II, III, a VF, V 2-6, Troponin elevationMid LV and Apical LV-Catecholamine storm; -Direct myocardial toxicity; -Microvascular spasmACEI, BB, Diuretic, single antiplatelet, statin; Anti-snake venomPartial recovery in 1 mo and complete in 5 mo (ECHO)
Abroug et al[29]Androctonus australisPatient 1: Basal ballooning of left and right ventricles; CAG not done; Troponin elevation; ST depression in four precordial leads; No other causes to explain the cardiac dysfunction. Patient 2: Impaired systolic function on echocardiogram. Basal ballooning on cardiac MRI in 24 hours; CAG not done; Troponin and ProBNP elevation; No other causes to explain the cardiac dysfunctionBasal ballooning in both patients-Catecholamine storm; -Microvascular dysfunction-CPAP, Dobutamine infusion; -No management mentionedPatient 1: Discharged in 5 d, MRI in one month was normal. Patient 2: Discharged in 4 d with normal LV function on repeat echocardiography examination before discharge
Miranda et al[23]Tityus serrulatusApical ballooning with hypokinesia; CAG not done; ST segment elevation in V1-V3, DI and aVL; No other causes to explain the cardiac dysfunctionApical-Alpha toxins act on voltage-gated sodium channels causing catecholamine storm; -Cytokine storm-IV furosemideDay 6 - asymptomatic, discharged; Cardiac MRI in 7 mo showed complete recovery of wall motion in apical region
Jain et al[27]Mesobuthus tamulusApical, apicolateral hypokinesia; CAG not done; ST segment elevationin V1-V3 and T wave inversion; Absence of other causes of cardiac dysfunctionApical-Catecholamine storm; -Microvascular dysfunction-Systemic steroids, inotropic drugs;-Improved LVEF in 7 d; -Cerebellar infarction with clinical signs
Bianchi et al[24]Pelagia noctiluca - A common Mediterranean jellyfishApical akinesis with severe left ventricular dysfunction; Absence of CAG; Acute myocardial infarction including persistent ST elevation despite thrombolysis performed for symptom relief and raised TroponinApical and mid-ventricular-Direct toxicity; -Catecholamine storm; -Cytokine storm-Symptomatic managementImproved. Completely symptom free, improved LVEF in 7 d
Tiong et al[25]Carukia barnesi - A cubozoan/box jellyfish found in AustraliaMid-ventricular stress cardiomyopathy with apical sparing; No CAG; Persistent hyperacute T waves, rise in troponinMid-ventricular ballooning with apical sparing-Sympathetic overdrive; -Catecholamine storm-Supportive with high flow oxygen, morphine; -Magnesium sulfate IV- Improved, discharged in 3 d