CASE REPORT article

Front. Cardiovasc. Med.

Sec. Coronary Artery Disease

Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1598373

This article is part of the Research TopicCase Reports in Coronary Artery Disease: 2025View all 5 articles

Takotsubo Cardiomyopathy Associated with Protobothrops mucrosquamatus Envenomation: A Case Report

Provisionally accepted
Handong  WuHandong WuKechun  ZhouKechun ZhouXiaotong  MaXiaotong Ma*
  • Lishui Central Hospital, Lishui, China

The final, formatted version of the article will be published soon.

Background: Protobothrops mucrosquamatus, commonly known as the Taiwan habu, is a highly venomous snake species. Its venom is rich in haemotoxins and neurotoxins, capable of inducing severe coagulopathy, tissue necrosis, and multi-organ damage. However, to date, there have been no reported cases of Takotsubo cardiomyopathy (TTS) triggered by envenomation from P. mucrosquamatus. TTS is characterised by transient left ventricular dysfunction precipitated by acute stress events and is typified by abnormalities in left ventricular wall motion, often mimicking the clinical presentation of coronary artery disease. Case introduction: This report presents a rare case of Takotsubo cardiomyopathy (TTS) triggered by envenomation from P. mucrosquamatus. Following the snakebite, the patient rapidly developed severe pain and bleeding at the bite site, and subsequently experienced acute chest tightness and chest pain during hospitalisation. To elucidate the aetiology, the patient underwent a series of investigations, including electrocardiography, transthoracic echocardiography, and coronary angiography, which ultimately confirmed the diagnosis of TTS. The patient received comprehensive treatment comprising administration of anti-venom serum to neutralise the venom, fluid resuscitation, and antiplatelet therapy. The clinical condition gradually stabilised, and the patient was eventually discharged in good health. Conclusion: Protobothrops mucrosquamatus envenomation may precipitate Takotsubo cardiomyopathy (TTS). Given the considerable overlap in early clinical presentation between TTS and acute myocardial infarction (AMI), early utilisation of echocardiography, coronary angiography, and fractional flow reserve (FFR) assessment is crucial for accurate diagnosis. The cornerstone of treatment lies in the prompt and adequate administration of anti-venom serum, combined with fluid resuscitation and supportive symptomatic care. The judicious use of antiplatelet agents after restoration of coagulation function is generally considered safe and does not significantly increase the risk of bleeding.

Keywords: Takotsubo Cardiomyopathy(TTS), Protobothrops mucrosquamatus, Echocardiography, Coronary Angiography, Fractional flow reserve (FFR), Snake venom

Received: 23 Mar 2025; Accepted: 19 May 2025.

Copyright: © 2025 Wu, Zhou and Ma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Xiaotong Ma, Lishui Central Hospital, Lishui, China

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