ACUTE MYOCARDIAL INJURY following animal venom injec-tion has been reported in the literature. 1-3 Brown and Dewar described a case of myocardial infarction after Vipera berus (European viper or common adder) bite. I They postulated that infarction resulted from arterial thrombosis due to severe hypotension. Askanas implicated a similar mechanism in a case ofposterior myocardial infarction aftera snakebite. 2 Aravanis and co-workers also described a case ofmyocardial infarction after a viper bite3 and suggested this was a direct cardiotoxic effect of thevenom. We report the first recorded case of acute myocardial infarction following the bite ofa banded Gilamonster (Helo-derma suspectwfn cinctum) in a previously healthy young man. The clinical history and the biochemical data available suggest that mechanisms different from those previously suggested were likely involved.

Report of a Case The patient, a 23-year-old mnale herpetologist, was bitten by a banded Gila monster on his left forearm after the animal was captured near Lake Mead in Nevada. The animal's jaws were immediately pried open using two'pieces of iron as levers. The total bite exposure time was about l/2 minutes. The patient reached the University Medical Center of Southern Nevada in Las Vegastwo hours after the bite. On initial physical examination in the emergency depart-ment, the young man was awake, oriented, and complaining of dizziness and left forearm pain. His blood pressure was 76/54 mm of mercury, his pulse rate was 140 beats per minute, and respirations were 18 per minute. The heart and lungs were normal to auscultation. Inspection of the bite wound showed a circle, 4cm in diameter, formed by 12 teeth marks. The area of the bite was very tender and indurated with a surrounding area oferythema and edema. The patient didnot have chest discomfortor shortness-ofbreath. He was immediately placed in Trendelenburg's position and intravenous infusions of 1,000 ml of normal saline and 250 ml of 5% dextrose in water were started at full flow. An electrocardiogram was done and showed a right bundle branch block, a left posterior fascicular block, and ST-seg-ment changes suggestive of an acute anterolateral infarct