Background: Scorpion envenomation is an important public health hazard in tropical and sub- tropical regions. Envenomation by scorpions can result in a wide range of clinical effects, including, cardiotoxicity, neurotoxicity and respiratory dysfunction. Biomarkers play an important role in the early diagnosis and management of patients with the cardiotoxicity related to scorpion sting. Diagnosis of myocardial injury at an early stage in the emergency department is often difficult. A recently proposed biomarker, heart fatty acid binding protein (H-FABP) has been found to appear in the circulation superior to that of cardiac troponins in the early hours of scorpion sting. Objective: The objective of this study was to evaluate the clinical reliability of heart-type fatty acid-binding protein (h-FABP) in identifying patients with the cardiotoxicity in the early hours following scorpion sting. Methods: troponin I (in laboratory) and H-FABP were performed on 246 patients who presented with scorpion sting with duration since onset ranging from 20 minutes to 2 hours. Results: Data of the 246 patients were analyzed. H-FABP had a higher sensitivity of 76.40% and a specificity of 96.10% compared with 58.30% and 98% for troponin I respectively (at first 6 hours).Conclusion: H-FABP was found to be a better biomarker of cardiac necrosis in the early hours in the diagnosis of non-conclusive ECG in patients with scorpion sting