Critical Care: Fellow Case Report Slide: Critical Care I |

Acute ST Elevation Myocardial Infarction Related to Carbon Monoxide Poisoning in a Young Patient Without Coronary Artery Disease FREE TO VIEW

Yihenew Negatu, MD; Will Healy, MD; Montoya Taylor, MD; Jerome Stasek, MD
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Ohio State University College of Medicine, Columbus, OH

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):262A. doi:10.1016/j.chest.2016.08.275
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SESSION TITLE: Fellow Case Report Slide: Critical Care I

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Sunday, October 23, 2016 at 03:15 PM - 04:15 PM

INTRODUCTION: Carbon monoxide (CO) is one of the leading causes of poisoning deaths in the United States. Non-ST elevation myocardial Infarction (NSTEMI) has been reported in moderate to severe CO poisoning. However,ST elevation MI (STEMI) with clean coronaries due to CO poisoning in young patients with no risk factors appears to be rare.

CASE PRESENTATION: A 26 years old male was brought to Emergency Department after he was found unresponsive at a closed garage in his vehicle.On arrival,vital signs showed pulse rate 111/min,respiratory rate 28/min,blood pressure 125/80 mmHg, temperature 98°F and oxygen(O2) saturation of 100% on 100%O2 with non-rebreather mask.On exam,Glasgow Coma Scale was 9/15 with no focal neurologic deficit.The rest of exam was unremarkable.Laboratory revealed lactate 9.3mmol/L, troponin 0.24ng/ml and carboxyhemoglobin 32.8%(Fig.1).Electrocardiogram (EKG) showed only sinus tachycardia.CT head was normal.Intravenous fluid was administered and 100%O2 was continued.Hyperbaric oxygen treatment(HBOT) in ED was not successful because of vomiting.His mentation normalized in 6hrs.A troponin of 15.4ng/ml was measured by routine monitoring after 22hrs.EKG showed ST elevation in the leads V2-V4(Fig.2).He was given aspirin,clopidogrel and heparin.Cardiac catheterization showed clean coronaries.Troponin peaked at 28.7ng/ml after 28hrs.Echocardiogram showed ejection fraction of 45-50% with global hypokinesis.Antithrombotic medications were stopped.He received 2 successful sessions of HBOT.Patient continued to be asymptomatic but ST elevation persisted on EKG. Patient was discharged stable on the 4thday.

DISCUSSION: Cardiac injury in CO poisoning occurs due to hypoxia,direct toxic effect and increased thrombogenicity.Cardiovascular manifestations of CO poisoning is in general understudied.Satran et al studied 230 patients with moderate to severe CO poisoning & 37% of them had evidence for troponin elevation.STEMI was the uncommon in this study.There are limited case reports published on STEMI after CO poisoning.Coronary angiogram in many of these cases showed obstructive lesions.The persistent ST elevation and marked rise of troponin in the setting of clean coronaries in a young patient without risk factors was a unique presentation in our case.

CONCLUSIONS: CO poisoning can cause STEMI even in the absence of coronary obstruction. Physicians should keep in mind CO poisoning as a potential cause for STEMI.

Reference #1: Hampson NB et al.Undersea Hyperb Med 2007

Reference #2: Satran D et al.JACC 2005;45

Reference #3: Soohyun Kim et al.Korean Circ J 2012;42

DISCLOSURE: The following authors have nothing to disclose: Yihenew Negatu, Will Healy, Montoya Taylor, Jerome Stasek

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