Myocardial infarction during treatment of Crotalinae envenomation: A case report

While myocardial infarction is a rare, but known, potential side effect of snakebite envenomation, snake antivenom has thus far not been associated with any cardiovascular adverse events. We report the case of a 71-year-old man who developed an anterolateral MI during administration of Crotalidae immune F(ab')2 (equine) (ANAVIP), given as treatment for Crotalidae envenomation. The patient required cardiac catheterization with stenting of the left anterior descending artery and was discharged two days later on long-term clopidogrel and aspirin. Treatment of MI in the setting of envenomation should mirror typical management, with consideration of additional antivenom if the ischemia is determined to be venom-induced. Clinicians should have a high index of suspicion for patients with chest pain after snake envenomation or administration of antivenom. [Display omitted] •In the United States, most clinically significant snake envenomations are by the Crotalinae subfamily of Viperidae.•Crotalinae venom commonly is hemotoxic, resulting in coagulopathy/thrombocytopenia, with some rare thrombotic events noted.•Treatment with F(ab’)2 ANAVIP antivenom is currently the standard of care for envenomed patients.•We report a case of a patient who had a myocardial infarction after Crotalinae envenomation and treatment with antivenom.