Profile of cardiac complications of snake bite.

The present study was conducted in 30 cases of snake bite to understand fully the intricacies of the cardiac profile and to render help in the management of the problem arising out of them. All were subjected to routine and specific investigations (ECG, X-ray Chest, SGOT). The present study concluded that 57 per cent of patients of snake bite were in 2nd and 3rd decades of life. Viperine snake bite occurred in 93 per cent and elapide snake bite in 7 per cent of cases. Cardiotoxicity was seen in only 25 per cent patients with viperine bite. Seventy-six per cent of the patients presented within 24 hours of the bite. Seventy per cent of patients had haemorrhagic manifestations and 30 per cent had cardiotoxicity. The disturbance in heart rate was seen in 47 per cent, rhythm disturbance in 6.7 per cent, tachycardia in 36.7 per cent and bradycardia in 10 per cent cases. Hypertension was found in 6.7 per cent, hypotension in 16.7 per cent. Thirty per cent of patients had gallop rhythm and it persisted in 16.6 per cent patients till discharge. One patient had evidence of pulmonary edema and one had basal congestion. Cardiomegaly on chest X-ray was found in one patient and elevated SGOT titres were found in ten per cent. Common electrocardiographic changes were sinus tachycardia, sinus arrhythmia (6.6%), sinus bradycardia (10%), tall T-wave in V2 (3.3%), pattern suggestive of acute anterior wall infarction with reciprocal changes (3.3%), myocardial ischemia (10%), non-specific ST-T changes (16.7%) and atrioventricular block (3.3%). The mortality rate was 10 per cent and all these patients had bleeding manifestations and abnormal electrocardiograms.

Treadmill exercise testing in asymptomatic chronic smokers to detect latent coronary heart disease.

The treadmill exercise test has been performed in 50 chronic smokers and 50 non-smokers (93 males and 7 females) who were not having any clinical or electrocardiographic manifestation of ischemic heart disease. The test was positive in 18% chronic smokers and 4% in non-smokers, the chances of positivity of stress test was 4-5 times greater in chronic smokers than in non-smokers. The duration of smoking and number of/cigarettes/bidis smoked per day were directly proportional to the incidence of a positive stress test. There was no significant difference in the incidence of a positive exercise test amongst purely cigarette smokers (17.64%), purely bidi smoker, (16.16%), and in both bidi and cigarette smokers (20%). The study, therefore, suggests that chronic heavy smoking is more frequently associated with asymptomatic ischemic heart disease, as compared to non-smokers and stress testing of persons with coronary risk factors important for detection of latent IHD.