{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:50:45Z","timestamp":1784782245754,"version":"3.55.0"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T00:00:00Z","timestamp":1736121600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T00:00:00Z","timestamp":1736121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Trop Med Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hump-nosed viper (Hypnale species) bites are an important cause of mortality and morbidity in southern India and Sri Lanka, accounting for 27 and 77% of venomous snake bites, respectively. Previously, we knew them to be moderately venomous snakes, primarily causing local envenomation. However, recent reports have indicated severe systemic envenomation incidents, which include hemostatic dysfunction, microangiopathic hemolysis, kidney injury, myocardial toxicity, and even death. The literature rarely reports cardiac manifestations from hump-nosed viper bites, and all reported cases show cardiac manifestations within hours of the snake bite. The literature did not report late presentations of cardiac manifestations. Here, we report a case of hump-nosed viper bite complicated with type 2 myocardial infarction and acute pulmonary oedema secondary to acute heart failure in a Sri Lankan female presented to the National Hospital of Colombo, Sri Lanka, on day 3 after the snake bite.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A local hospital transferred a previously healthy 39-year-old female from Kegalle, Sri Lanka, to our hospital for further condition management. We identified the offending snake as a hump-nosed viper after she reported a history of snake bites 3\u00a0days ago. She complained of chest tightness on day 3 of the illness and was found to have acute heart failure precipitated by troponin-positive non-ST elevation myocardial infarction in initial investigations. We performed a CT coronary angiography along with a metabolic screening, revealing normal coronary arteries and a negative metabolic screening. Supportive therapy with loop diuretics and oxygen managed her condition, and a follow-up 2D echocardiogram revealed complete recovery of her cardiac function. She was asymptomatic 3\u00a0months into the follow-up. Therefore, we concluded that the case was a venom-induced type 2 myocardial infarction leading to heart failure with acute pulmonary oedema, as the CT coronary angiogram showed normal coronary arteries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s41182-024-00645-w","type":"journal-article","created":{"date-parts":[[2025,1,5]],"date-time":"2025-01-05T23:32:36Z","timestamp":1736119956000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A rare case of acute myocardial infarction with heart failure following hump-nosed viper bite in a Sri Lankan female"],"prefix":"10.1186","volume":"53","author":[{"given":"W. M. D. A. S.","family":"Wanninayake","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tilan","family":"Aponso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manohari","family":"Seneviratne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhanapala","family":"Dissanayake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,6]]},"reference":[{"issue":"1","key":"645_CR1","doi-asserted-by":"publisher","first-page":"15","DOI":"10.11646\/zootaxa.2232.1.1","volume":"2232","author":"K Maduwage","year":"2009","unstructured":"Maduwage K, Silva A, Manamendra-Arachchi K, Pethiyagoda R. A taxonomic revision of the South Asian hump nosed pit vipers (Squamata: Viperidae: Hypnale). Zootaxa. 2009;2232(1):15.","journal-title":"Zootaxa"},{"key":"645_CR2","volume-title":"An account of the interior of Ceylon and of its inhabitants","author":"J Davy","year":"1821","unstructured":"Davy J. An account of the interior of Ceylon and of its inhabitants. London: Longman, Hurst, Rees and Brown; 1821."},{"issue":"1","key":"645_CR3","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1186\/s13256-017-1484-z","volume":"11","author":"NL de Silva","year":"2017","unstructured":"de Silva NL, Gooneratne L, Wijewickrama E. Acute myocardial infarction associated with thrombotic microangiopathy following a hump-nosed viper bite: a case report. J Med Case Rep. 2017;11(1):305.","journal-title":"J Med Case Rep"},{"key":"645_CR4","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.toxicon.2018.03.014","volume":"148","author":"RN Rathnayaka","year":"2018","unstructured":"Rathnayaka RN, Ranathunga PN, Ranaweera J, Jayasekara K, Kularatne SAM. Cardiac arrest and atrial fibrillation in a patient after hump-nosed pit viper (Hypnale hypnale) bite. Toxicon. 2018;148:33\u20139.","journal-title":"Toxicon"},{"key":"645_CR5","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.toxicon.2012.10.013","volume":"61","author":"K Maduwage","year":"2013","unstructured":"Maduwage K, Isbister GK, Silva A, Bowatta S, Mendis S, Gawarammana I. Epidemiology and clinical effects of hump-nosed pit viper (Genus: Hypnale) envenoming in Sri Lanka. Toxicon. 2013;61:11\u20135.","journal-title":"Toxicon"},{"key":"645_CR6","first-page":"17","volume":"2","author":"K Maduwage","year":"2011","unstructured":"Maduwage K, Hodgson WC, Konstantakopoulos N, O\u2019Leary MA, Gawarammana I, Isbister GK. The in vitro toxicity of venoms from South Asian hump-nosed pit vipers (Viperidae: Hypnale). J Venom Res. 2011;2:17\u201323.","journal-title":"J Venom Res"},{"key":"645_CR7","unstructured":"Sellahewa KH, Rathnayake N, Wijewickrama E. Hump-nosed pit vipers and their bites in Sri Lanka. Srilankan Med Assoc J. 2022. https:\/\/slma.lk\/"},{"issue":"2","key":"645_CR8","first-page":"70","volume":"44","author":"SL Seneviratne","year":"1999","unstructured":"Seneviratne SL, Gunatilake SB, Fonseka MM, Adhikari AA, De Silva HJ. Lack of myocardial damage following Sri Lankan Russell\u2019s viper and hump-nosed viper bites. Ceylon Med J. 1999;44(2):70\u20133.","journal-title":"Ceylon Med J"},{"key":"645_CR9","first-page":"63","volume":"52","author":"M Maheshwari","year":"2004","unstructured":"Maheshwari M, Mittal SR. Acute myocardial infarction complicating snake bite. J Assoc Physicians India. 2004;52:63\u20134.","journal-title":"J Assoc Physicians India"},{"issue":"2","key":"645_CR10","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1016\/j.wem.2020.12.006","volume":"32","author":"RMMK Namal Rathnayaka","year":"2021","unstructured":"Namal Rathnayaka RMMK, Nishanthi Ranathunga PA, Kularatne SAM. Syndrome following Hypnale zara (hump-nosed pit viper) bite in Sri Lanka. Wilderness Environ Med. 2021;32(2):210\u20136. https:\/\/doi.org\/10.1016\/j.wem.2020.12.006.","journal-title":"Wilderness Environ Med"}],"container-title":["Tropical Medicine and Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s41182-024-00645-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s41182-024-00645-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s41182-024-00645-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T10:04:19Z","timestamp":1736157859000},"score":1,"resource":{"primary":{"URL":"https:\/\/tropmedhealth.biomedcentral.com\/articles\/10.1186\/s41182-024-00645-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,6]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["645"],"URL":"https:\/\/doi.org\/10.1186\/s41182-024-00645-w","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-4149803\/v1","asserted-by":"object"}]},"ISSN":["1349-4147"],"issn-type":[{"value":"1349-4147","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,6]]},"assertion":[{"value":"30 March 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 October 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 January 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Informed written consent for publication of details was taken from the patient. Consent form can be made available to the editor on request.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"2"}}