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Catecholamine-induced cardiomyopathy resulting from life-threatening funnel-web spider envenoming

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We present two cases of cardiomyopathy in life-threatening funnel-web spider envenoming. A 33-year-old man bitten by a male Sydney funnel-web spider developed autonomic and neuromuscular excess, pulmonary oedema, hypotension and cardiogenic shock. He was treated with antivenom, dobutamine, noradrenaline and high-dose insulin, and recovered over 4 days. Echocardiograms showed severe systolic dysfunction, and high catecholamine concentrations were measured in his blood. A 13-year-old girl developed cardiogenic shock after a funnel-web spider bite, confirmed on echocardiogram treated with antivenom and dobutamine. Funnel-web spider envenoming appears to cause catecholamine-induced cardiomyopathy and cardiogenic pulmonary oedema resulting from catecholamine excess. Antivenom did not reverse the cardiomyopathy.

Clinical records

Patient 1

A 33-year-old man was bitten by a male Sydney funnel-web spider (Box 1) in Newcastle and developed perioral paraesthesia, widespread fasciculations, diaphoresis, hypersalivation and difficulty breathing within 5 minutes. He immediately called an ambulance and was treated with 3 mg atropine on the way to hospital. He arrived in the emergency department (40 minutes after being bitten) with shortness of breath (respiratory rate, 28 breaths per minute), hypoxia, mild hypertension (blood pressure, 143/104 mmHg) and tachycardia (150 beats per minute) with widespread ST changes…