{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:50:43Z","timestamp":1784782243893,"version":"3.55.0"},"reference-count":44,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2014,9,28]]},"abstract":"<jats:p>\u2018The Big four\u2019 are the most poisonous snakes in India, and especially in Kerala. These include the cobra, the viper, the krait and the sea snake. Most of the poisonous snakebites in India occur in Kerala. We believe there are only a few reports of myocardial infarction after snakebites and most of these are viper bites. We believe this is the second case of primary angioplasty for a snakebite. There are at least a few potential issues in performing a primary angioplasty in a snakebite case, namely (1) Is it a thrombus or a spasm? (2) Are the bleeding parameters deranged? Will the patient tolerate tirofiban and other glycoprotein (GB) 2b3a inhibitors? Will he develop dangerous bleeding due to the high dose of heparin needed? Further, would we save the patient from myocardial infarction only to lose him to renal failure, both due to the nephrotoxicity of the venom, the kidney being further damaged by the contrast media used for the angioplasty? We discuss all these issues as they crossed our mind, and hope it will help further treatment in others. We would like to review the available literature on these points and describe a recent case of ours.<\/jats:p>","DOI":"10.1136\/bcr-2013-201912","type":"journal-article","created":{"date-parts":[[2014,10,23]],"date-time":"2014-10-23T10:04:20Z","timestamp":1414058660000},"page":"bcr2013201912","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["+Ophitoxaemia and myocardial infarction\u2014the issues during primary angioplasty: a review"],"prefix":"10.1136","volume":"2014","author":[{"given":"Prabha Nini","family":"Gupta","sequence":"first","affiliation":[{"name":"Department of Cardiology, Medical College Hospital, Trivandrum, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinesh","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical College Hospital, Trivandrum, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preetham Kumar","family":"Francis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical College Hospital, Trivandrum, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sajith Vamadevan","family":"Shylaja","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical College Hospital, Trivandrum, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2014,10,23]]},"reference":[{"key":"2025082802381376000_2014.oct23_2.bcr2013201912.1","unstructured":"Mathew JL , Gera T . 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The management of Poisonous Snakebites. Guidelines American College of Surgeons 2004. Commitee on Trauma 1\u20134."},{"key":"2025082802381376000_2014.oct23_2.bcr2013201912.11","doi-asserted-by":"crossref","first-page":"465","DOI":"10.7196\/SAMJ.3865","article-title":"Snakebite: admissions at a tertiary health care center in Maharashtra, India","volume":"100","author":"Inamdar","year":"2010","journal-title":"S Afr Med J"},{"key":"2025082802381376000_2014.oct23_2.bcr2013201912.12","unstructured":"Snakebite Management in Asia and Africa. A2, Guidelines produced by the Pakistan Medical Research Council. 1\u2013162. by Huma Qureshi. email of adviser Ian D Simpson. 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