Evidence of myocardial ischaemia in severe scorpion envenomation - Myocardial perfusion scintigraphy study

Objective: To explore the myocardial perfusion by thallium-201 scintigraphy for patients with evidence of myocardial damage after scorpion envenomation. Design: Prospective study over 1-year period. Setting: Medical intensive care unit of a university hospital (Sfax, Tunisia). Patients: We have prospectively included six patients admitted for scorpion envenomation over a period of 1 year in the 22-bed intensive care unit (ICU) of our university hospital. The evidence of myocardial damage was confirmed by electrocardiography and echocardiography in all patients. Myocardial perfusion scintigraphy (Tl-201 scintigraphy) coupled with radionuclide ventriculography (Tc-99m) was performed for all patients, occurring 32 h on average (range 12-72 h) after the sting. Results: Radionuclide ventriculography was abnormal in all cases; the abnormalities observed were similar to those observed by echocardiography. Moreover Tl-201 scintigraphy showed evidence of myocardial hypoperfusion in all cases. The myocardial hypoperfusion grade and localisation were more marked in the abnormal localisation shown by echocardiography and electrocardiography, compared to the normal wall. Repeated studies, obtained only in two patients within 6 and 15 days, respectively, showed considerable, but not complete, improvement of wall motion and myocardial perfusion. Segments with improved perfusion showed greatly improved regional wall motion. Conclusion: This study confirms the evidence of myocardial hypoperfusion after severe scorpion envenomation.