Internal Medicine and Medical Investigation Journal

ISSN: 2474-7750

A Patient with Severe Bradycardia Five Years After Copperhead Snake Bite


Author(s): Farshid Etaee , Aaron B. Hesselson

Copperhead (Agkistrodon contortrix) snakes are responsible for approxi-

mately 40% of all pit viper envenomations in the US.

Case presentation:

: A 14-year-old girl was bitten by a copperhead snake bite. Electro-

cardiogram taken approximately one hour after envenomation showed sinus rhythm

with no acute ST or T wave changes. She was not administered anti-venom but was

monitored, treated with antibiotics and discharged without any significant complica-

tions after 2 days time. Approximately 5 years after the incident, she began having

issues of refractory constipation. Subsequently, she suffered from numerous episodes

of recumbent and ambulatory syncope outside of any acute gastrointestinal distress and

occurring without warning. A dual-chamber pacemaker (Medtronic™), programmed

for “rate-drop” response, was inserted in the patient.


Delayed sequelae from a copperhead snakebite appears to be possible

given our patient’s presentation. However, the mechanism of delayed autonomic

dysfunction and/or possible direct cardiac effect remains unclear

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