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Paper text:
centipedes ( class chilopoda , phylum arthropoda ) are slim , multisegmented arthropods with a single pair of legs per segment and one pair of antennae . the first pair of legs has been modified into two sharp stinging structures connected to muscular venom glands .
they spend most of their time underground , and they are nocturnal carnivores with a wide range of prey .
the species of medical importance is scolopendra sp , which has been described as the longest and most the aggressive tropical centipede .
we report one such systemic complication following centipede envenomation for its rarity , and to create awareness among health care workers and those involved in field work .
a 22 year - old male gardener was bitten by a centipede ( scolopendra sp ) on the radial aspect of his left middle finger while he was working .
the pain engulfed the entire hand and he himself applied cold pressure on the affected parts to obtain relief .
however , within 2 hours he began to have severe , retrosternal chest pain radiating to the left arm which was associated with sweating , nausea and vomiting .
he presented to the emergency department hospital 14 hours after the bite with complaints of continued anginal chest pain .
his blood pressure , pulse rate / minute and respiratory rate / minute were 90/60 mmhg , 74 , and 22 , respectively .
a 12-lead electrocardiogram ( ecg ) showed acute anterior st - segment myocardial infarction [ figure 1 ] .
the chest pain was not responsive to sublingual nitrates ; however , subsided after intravenous morphine .
echocardiography showed a hypokinetic anterior wall , with a left ventricular ejection fraction of 35% .
total cholesterol(130 - 200 mg / dl ) , triglyceride(50 - 160 mg / dl ) , low density lipoproetins ( ldl)-cholesterol ( less than 130 mg / dl ) and high density lipoproteins ( hdl)-cholesterol ( 35 - 65 mg / dl ) were 117 , 93 , 61 , and 38 mg / dl respectively .
troponin i level ( 0 - 0.4 ng / ml ) was markedly raised ( 13.2 g / l ) .
three days after admission , cardiac markers were within normal limits with the resolution of electrocardiographic abnormalities ; and , resolution of the anterior wall motion abnormality on echocardiography .
12-lead electrocardiography demonstrating acute anterior st - segment elevation myocardial infarction in the patient of the case report
centipede bites have been reported to cause constitutional and systemic symptoms including severe pain , local pruritus , headache , nausea , vomiting , anxiety , palpitations , local tissue swelling , erythema , necrosis , lymph node swelling , ischemia and rhabdomyolysis .
centipede venoms are complex mixtures containing 5-hydroxytryptamine , histamine , lipids , polysaccharides and various enzymes like proteinases , esterases etc . it is thought that the centipede venom is a lipid - toxin complex , similar to that of scorpion venom , which facilitates local cellular penetration and absorption .
gomes et al used animal models to demonstrate significant cardiovascular effects of scolopendra venom , mediated by histamine and a cardiodepressant factor designated as toxin - s , which is a high - molecular acidic and heat - labile cardiotoxic protein .
most authorities recognize the cardiodepressant toxin - s to be the lethal factor ( predatory ) and the histamine / serotonin components to be pain mediators ( defensive ) .
they also reported the presence of a smooth muscle contractile agent , which was recently confirmed to have muscarinic activity .
cardiac arrest in the toad after injecting the extract from the centipede scolopendra morsitans was demonstrated by mohamed et al , and the effect was blocked by giving atropine .
only two cases of acute coronary syndrome after centipede envenomation have been reported . even though the exact pathophysiology in both cases is unidentified , the most probable mechanisms for the present case could be acute release of inflammatory mediators inducing increased capillary permeability , inflammatory changes , hypotension and coronary artery spasm , which might have led to acute myocardial infarction with raised cardiac biomarkers .
absence of tachycardia despite hypotension , as observed in the present case , may be related to increased vagal response to centipede venom which was not documented previously in the literature .
this report highlights that the treating doctor shall be aware of possible serious cardiovascular complications while treating patients with a centipede ( scolopendra sp ) bite .
acute myocardial infarction ( ami ) following a centipede bite has been very rarely reported . here , we describe a 22 year - old man who had st - segment elevation ami after a centipede bite . 
 he presented with typical chest pain , electro and echocardiographic abnormalities , and elevated cardiac enzymes with normal coronary angiography . 
 the probable mechanisms were described . 
 practitioners treating centipede bites shall not consider it lightly , as centipede envenomation may produce a variety of systemic and local manifestations in susceptible individuals .