When Venom Meets the Coronary Artery: Anterior STEMI Following Exposure to Snake Envenomation: A Case Report

Background: Snake envenomation is a globally recognized neglected tropical disease that remains uncommon but potentially a catastrophic cause of cardiovascular toxicity. It has been documented to have hemotoxic and neurotoxic effects, along with its ability to induce direct myocardial ischemia, malignant arrhythmias, and cardiogenic shock that is often underestimated, particularly in non-endemic regions. Venom components can trigger a "thrombotic storm" through direct endothelial injury and hypercoagulability, posing significant diagnostic and therapeutic challenges for cardiology teams. Case presentation: Our case describes a 72-year-old Moroccan man with no documented prior comorbidities who presented to the emergency department with a one-week history of progressive dyspnea, orthopnea, and palpitations, later confirmed to have an acute anterior ST-segment elevation myocardial infarction (STEMI). He was immediately referred to our center for lifesaving intervention. Coronary angiography revealed a total proximal left anterior descending (LAD) artery occlusion in the absence of diffuse atherosclerotic disease. Despite successful primary percutaneous coronary intervention (PCI) with restoration of Thrombolysis in Myocardial Infarction (TIMI) grade III flow, the patient developed recurrent ventricular tachycardia and refractory cardiogenic shock. A subsequent physical examination revealed a bleeding wound on the right shoulder with two distinct pinpoint puncture marks, raising a high clinical suspicion of snake envenomation. Despite aggressive resuscitation efforts and a consultation with the National Toxicology Center for antivenom administration, the patient suffered a final pulseless cardiac arrest and was pronounced dead. Conclusion: This case highlights a rare but lethal intersection between snake envenomation and the development of acute myocardial infarction. It highlights a paradox where dual antiplatelet therapy might be neutralized by venom-derived enzymes, leading to rapid clinical deterioration despite successful mechanical revascularization. These findings emphasize that envenomation must remain part of the differential diagnosis in cases of atypical STEMI. Early clinical recognition, multidisciplinary collaboration with toxicology experts, and the availability of anti-venom therapy even in regions where snake bites are uncommon are critical factors for improving survival.