Abstract
BACKGROUND: Bothrops envenomation is a common medical emergency in tropical areas and is characterized by local and systemic complications, such as edema, coagulopathy, and tissue necrosis. Cardiovascular manifestations are rare and poorly documented, contributing to the complexity of its clinical management. CASE SUMMARY: We described a rare cardiac complication in a 65-year-old female patient, who initially presented with mild Bothrops envenomation. She experienced localized edema and erythema but with a lack of systemic symptoms. During the evaluation we detected asymptomatic sinus bradycardia and QTc prolongation (523 milliseconds) that progressed to severe arrhythmias that required implantation of a permanent pacemaker. Management included the administration of polyvalent antiphonic serum, fresh frozen plasma transfusions, and intensive care unit monitoring. Imaging and laboratory studies ruled out ischemic, metabolic, or electrolytic etiologies for the cardiac alterations. The patient recovered favorably after the intervention and was discharged without further complications. CONCLUSION: This case underscored the need for cardiac monitoring after snakebite envenomation as well as further research on venom-induced cardiotoxic mechanisms.