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A 44-year-old man, otherwise healthy, presented to the emergency room in February 2010 with an acute inferior wall myocardial infarction, secondary to an isolated total occlusion ( Fig 1 A) of the proximal right … J Emerg Med. They may occur in remote areas where advanced emergency healthcare services are unavailable. Med J Aust. Address correspondence to Dr Saunders, Department of Cardiothoracic Surgery, Barnabas Heart Institute, Newark Beth Israel Medical Center, 201 Lyons Ave, Ste G5, Newark, NJ 07112. Image. Stingray injury to the heart. Four days after admission, he was discharged home, asymptomatic, with the apparent assumption that no foreign body remained in the chest. Stings have been known to be fatal when major organs, such as the heart, are affected. Clipboard, Search History, and several other advanced features are temporarily unavailable. It is postulated, however, that slow migration of the foreign body and the surrounding fibrotic reaction impinging on the lumen would be a likely mechanism of action. J Emerg Med. Not only does the puncture itself cause injury and pain, but the stinger also releases a complex venom, which leads to intense pain at the puncture site. Survivor of a stingray injury to the heart. To date, there are only three reported survivors of this mode of penetrating cardiac injury, all inflicted by the living animal itself. The heart was exposed through a full sternotomy. The patient was free of other coronary disease. It’s possible for the heart to stop or for the body to go into shock after a stingray sting. A 44-year-old man, otherwise healthy, presented to the emergency room in February 2010 with an acute inferior wall myocardial infarction, secondary to an isolated total occlusion (, The patient did well for 6 months but was admitted in August 2010 with recurrent anginal symptoms. Angiogram showing totally occluded right coronary artery on the (A) left and the (B) opened vessel after stenting. Stingray injuries to the heart are rare, and survivors of this injury are even rarer. 1998 Feb;113(2):531-4. doi: 10.1378/chest.113.2.531. Approximately 750 to 1,500 are reported in the United States annually, involving either the trauma of the puncture wound or the envenomation from toxic glands running the length of the stingray barb .However, stingray injuries to the heart are rare, and survivors of this injury are even rarer. In addition, a foreign body was identified in close proximity to the stenosis (. Rarely, death from blood loss from puncture wounds to the heart or abdomen have happened. Stingray injuries are usually defensive actions, not attacks. Stingray injuries to the heart are rare, and survivors of this injury are even rarer. This causes an instinctive, defense mechanism of the stingray. Sting-ray injuries are common in Australasia, with over 200 cases presenting to emergency departments in Victoria, Australia over a 5-year period. By continuing you agree to the, https://doi.org/10.1016/j.athoracsur.2013.02.052, Stingray Barb Injury: A Cause of Late Coronary Occlusion and Stent Failure, View Large Stingray recipes abound throughout the world, with dried forms of the wings being most common. Upon removal of the barb, one of the retroserrations of the barb was actually engaged in the stent, causing disruption of the RCA. A stingray’s venom is not always life-threatening, but is extremely painful. This tract was surgically divided at the level of the pericardium, leaving a few millimeters of the visible stingray barb protruding from the heart anteriorly in the atrial ventricular groove. Cardiology and Department of Radiology, Barnabas Heart Institute, Community Medical Center, Toms River, New Jersey Stingray injuries to the heart are rare, and survivors of this injury are even rarer. A stingray injury is caused by the venomous tail spines, stingers or dermal denticles of rays in the order Myliobatiformes, most significantly those belonging to the families Dasyatidae, Urotrygonidae, Urolophidae, and Potamotrygonidae. Restenosis of the right coronary artery with stingray barb in close proximity. Naturalist, zoologist, conservationist, television personality, herpetologist. 18. It is stiletto thin and sharp, and its edges are lined with backward-pointing, harpoonlike, retroserrations (. pain, seizures and hypotension. effects of stingray venom included respiratory depression, hypotension, seizures, and a deleterious impact on the ani­ mals' cardiovascular systems [29]. The following is a report of a stingray injury, inflicted by a human, causing coronary complications 17 years after the injury was sustained. With the heart beating, a meticulous dissection was begun by sharp dissection of the serrated edges of the stingray barb from a thickened fibrotic reaction surrounding the barb. Wilderness Environ Med. The course of the stingray barb was through the pericardium, over the top of the right atrium, between the proximal RCA and the right ventricle, and down the atrial ventricular groove, stopping adjacent to the aortic root and the base of the anterior leaflet of the mitral valve. The causes of stingray injuries are due to cuts or lacerations by the whip-like action of the tail that puts the barbed stinger and the toxins located in the stinger’s sheath into the skin (sometimes so deep it may lacerate an organ). Copyright © 2013 The Society of Thoracic Surgeons. Therefore, this injury was not associated with the usual inflammatory response and tissue necrosis that can accompany an attack from a live stingray. Treatment Suggested treatments for stingray injury have included the application of numerous substances: macerated cock­ roaches, fish liver, tobacco juice, cactus juice, gasoline, If the sting caused a deep injury to the chest or abdomen, a trip to the hospital is necessary. They may occur in remote areas where advanced emergency healthcare services are unavailable. Terri Irwin. Kumar KR, Vennila R, Kanchana S, Arumugam M, Balasubramaniam T. Fibrinogenolytic and anticoagulant activities in the tissue covering the stingers of marine stingrays Dasyatis sephen … Over time the barb migrated and caused a transient ischemic attack after traversing her right common carotid artery!  |  10 There have been reports of chronic wounds secondary to stingray injuries.  |  Cystic Atrioventricular Node Tumor Excision by Minimally Invasive Surgery, Pulmonary Sequestration With Aberrant Arteries Arising From the Renal Artery and the Internal Thoracic Artery. Occupation. 2012 Oct;43(4):719. doi: 10.1016/j.jemermed.2011.07.027. 9 Additionally, the venom causes local vasoconstriction and ischemia, which can contribute to delayed wound healing as well. Famed environmentalist and entertainer Steve Irwin was killed by a stingray barb to the heart … There is an estimated 1500 stingray injuries reported annually in the United States. Therefore, a short segment of a reversed saphenous vein, without valves or size change, was grafted in the standard fashion from the proximal aorta to the RCA just distal to the ligation. 1938 — An autopsy demonstrated that a New Zealand woman died from a stingray bard that transfixed both ventricles of the heart. Stingray Barb Injury: A Cause of Late Coronary Occlusion and Stent Failure Stingray injuries to the heart are rare, and survivors of this injury are even rarer. Australian Venom Research Unit: "First Aid Information: Stingray." Survivor of a stingray injury to the heart. We use cookies to help provide and enhance our service and tailor content and ads. End-to-end reconstruction of the RCA after removal of the stent was not feasible because of the length involved. The following is a report of a stingray injury, inflicted by a human, causing coronary complications 17 years after the injury was sustained. Stingray stings usually happen by accident when someone steps on a stingray, resulting in injury to the legs or feet. Imaging plays an important role in the evaluation of stingray injuries. Stingray injuries to the heart are rare, and survivors of this injury are even rarer. Published by Elsevier Inc. All rights reserved. The mechanism of coronary artery occlusion from the presence of a long-standing foreign body, with the notable exception of intracoronary stents, has never been reported to our knowledge. Stingray-related fatalities (in humans) are extremely rare, partly because a stingray's venom, while extraordinarily painful, isn't usually deadly -- unless the initial strike is to the chest or abdominal area. The coronary was ligated proximally and distally to the stent, and an aortocoronary bypass was performed in the standard fashion with a reversed saphenous vein graft from the proximal aorta to the portion of the RCA near the acute margin of the heart. S tingray envenomation of the foot is a common marine injury. 2012 Jul;43(1):116-9. doi: 10.1016/j.jemermed.2010.06.027. Another unusual stingray injury resulted from the accidental ingestion of a stingray barb that became lodged in the throat of a 76 year-old woman [case report by Gan et al, 2008]. 156-160). When threatened, their primary reaction is to swim away. In Annales de chirurgie plastique et esthetique (Vol. Sting rays will not kill you if you touchy them. © 2013 The Society of Thoracic Surgeons. Stingray recipes abound throughout the world, with dried forms of the wings being most common. Penetrating cardiac injury from a wooden knitting needle. DOI: https://doi.org/10.1016/j.athoracsur.2013.02.052. [1] Usually, a person will be fishing in shallow water and accidentally step on the stingray. They are necessarily dangerous. IT'S been 11 years since Steve Irwin tragically died after a stingray barb pierced his heart, but now one US doctor has made an extraordinary claim the crocodile hunter "didn’t have to die". Also what liked Steve Irwin was the fact he pulled the barn or of his heart and did not leave it in and go to the hospital. Australian Venom Research Unit: "First Aid Information: Stingray." ... "He had a two-inch-wide injury over his heart with blood and fluid coming out of … This patient's stingray injury is unique. One of the beautiful bluespotted stingrays at the Georgia Aquarium s pregnant, and could give birth to her two pups and day! However, stingray injuries to the heart are rare, and survivors of this injury are even rarer. Approximately 750 to 1,500 are reported in the United States annually, involving either the trauma of the puncture wound or the envenomation from toxic glands running the length of the stingray barb [. 5–10 Envenomation from a freshwater stingray … Journal of the Louisiana State Medical Society, July-August, 2007. http://www.TheBestVacationDeal.net Is it safe to swim with Stingrays following the death of Steve Irwin? Some people have died as a result of stings in their chests and abdomens. 2001; 175 (1):33–34. Stephen Robert Irwin (22 February 1962 – 4 September 2006), nicknamed "The Crocodile Hunter" was an Australian zookeeper, conservationist, and television personality. We describe the case of a 24-year-old man with tension pneumothorax due to a Himantura fai stingray injury to the left chest. The Epidemiology Evaluation and Management of Stingray Injuries. NLM Stingray injuries to the heart are rare, and survivors of this injury are even rarer. 2. Stingray injuries to the chest are rare but potentially life-threatening. Journal of the Louisiana State Medical Society, July-August, 2007. On September 22, 2010, the patient was electively taken to the operating room for the planned procedure of removal of the foreign body and grafting of the RCA. Repeat catheterization showed in-stent stenosis, which was reopened by deploying a Taxus Paclitaxel-Eluting stent (Boston Scientific) within the previously placed Promus stent, with full restoration of luminal diameter. The chest wound was unremarkable, with no external bleeding or evidence of a foreign body. Cardiac wound caused by the spine of the stingray. To date, there are only three reported survivors of this mode of penetrating cardiac injury, all inflicted by the living animal itself. To date, there are only three reported survivors of this mode of penetrating cardiac injury 2, 3, 4. Irwin was likely killed not by the sting so much as the fact that the stingray's spear pierced his heart and caused him to bleed to death, according to news reports. For example, in Malaysia and Singapore, stingray is commonly grilled over charcoal, then served with spicy sambal sauce, or soy sauce. To date, there are only three reported survivors of this mode of penetrating cardiac injury, all inflicted by the living animal itself. The stingray barb is a remarkable feat of bioengineering. Stingray on boat stabs man in heart - Oct. 19, 2006; CNN.com: Irwin's last moments caught on videotape - Sept. 5, 2006; ReefQuest Centre for Shark Research: Biology of Sharks and Rays; Stingray Injuries, Envenomation, and Medical Management A sensational case of death was that of the famous Australian naturalist Steve Irwin on 4 September 2006 by a penetrating stingray injury to the heart while filming off the Great Barrier Reef. 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