RIGHT-VENTRICULAR DYSFUNCTION FOLLOWING SEVERE SCORPION ENVENOMATION

Objective: Evaluation of right ventricular (RV) performance in patient s presenting with pulmonary edema following scorpion envenomation. Des ign: Cohort study. Setting: medical intensive care unit of a teaching hospital. Patients: Eight consecutive adult patients stung by yellow s corpion Androctonus australis and presenting with pulmonary edema at h ospital admission. Interventions: In all patients, standard hemodynami c parameters and RV volumes were measured using a pulmonary artery cat heter equipped with a rapid responding thermistor enabling measurement of RV ejection fraction (RVEF). Measurements: Hemodynamic evaluation was performed at the time of hospital admission prior to any therapeut ic intervention and just before the removal of the pulmonary catheter (2.3+/-0.5 days after admission) in the surviving patients (n=7). Resu lts: All patients had a decreased RVEF (24+/-7%) and cardiac index (2. 44+/-0.5 L/min/m(2)) and increased pulmonary artery occlusion pressure (23+/-6 mm Hg), Right ventricular end-systolic pressure/volume ratio was decreased (.56+/-.19 mm Hg/mL/m(2)), suggesting an altered RV cont ractility. Follow-up evaluation performed in survivors, without any in otropic support, showed hemodynamic changes reflecting a trend toward full recovery. Right ventricular ejection fraction and cardiac index i mproved markedly (from 24+/- 7% to 39+/-10% and from 2.44+/-0.5 to 4+/ -.3L/min/m(2), respectively), Pulmonary artery occlusion pressure, pea k Systolic pulmonary artery pressure, and mean pulmonary artery pressu re decreased significantly from baseline values (12+/-3 mm Hg, 29+/-5 mm Hg, and 20+/-4 mm Hg, respectively). Right ventricular end systolic pressure/volume ratio remained almost constant, suggesting that after load enhancement accounted predominantly for RVEF improvement. Conclus ion: These data show that RV function impairment is associated with le ft ventricular dysfunction, suggesting similarities between left ventr icular and RV alterations following severe scorpion envenomation provi ding further arguments to the hypothesis of scorpionic myocarditis.