Karbonmonoksit Zehirlenmesine Bağlı ST Segment Elevasyonlu Miyokard Enfarktüsü

Year 2015, Volume: 6 Issue: 3, 46 - 48, 01.07.2015

Şeref Kerem Çorbacıoğlu Gülşah Çıkrıkçı Yunsur Çevik

Abstract

Giriş: Karbon monoksit (CO) zehirlenmeleri sıklıkla nörolojik ve
solunumsal semptomlarla seyreden yaygın olarak karşılaşılan
ciddi zehirlenmelerdir. Ancak literatürde nadiren de olsa ciddi
aritmiler, myokard enfarktüsü gibi zehirlenmeye bağlı mortal
olabilecek kardiyak komplikasyonlar da bildirilmiştir. CO
zehirlenmelerinde kardiyak değerlendirme ve takip mortalitenin
azaltılması açısından oldukça önemlidir.
Olgu Sunumu: Bu yazıda, özgeçmişinde özellik olmayan ve CO
zehirlenmesi sebebiyle acil servise başvuran ve göğüs ağrısı
olan 48 yaşındaki erkek hastada saptanan, CO zehirlenmesinin
tetiklediğini düşündüğümüz ST segment elevasyonlu myokard
infarktüsü (STEMI) vakası sunulmuştur.
Sonuç: Karbon monoksit zehirlenmelerinde myokardiyal iskemi
beklenen bir klinik bir durum olmakla birlikte STEMI nadir görülen
bir durumdur. Genellikle karbon monoksit zehirlenmesine bağlı
STEMI hastalarının anjiyografilerinde altta yatan bir koroner arter
hastalığı saptansa da daha nadir durumlarda koroner anatomi
tamamen normal olabilmektedir.

Keywords

Karbonmonoksit, zehirlenme, myokard infarktüsü, anjiyografi

ST-Segment Elevation Myocardial Infarction Due to Carbon Monoxide Poisoning

Abstract

Introduction: Carbon monoxide (CO) intoxications, which are often characterized by neurological and respiratory symptoms, are commonly encountered serious poisonings. However, in the literature, although cardiac complications due to poisoning are rarely mortal, conditions such as serious arrhythmias and myocardial infarction have also been reported. Cardiac evaluation and follow-up on CO poisoning is very important for reducing mortality.Case Report: In the present case, we report a ST-segment elevation myocardial infarction (STEMI) believed to be triggered by CO poisoning established in a 48-year-old male patient, whose medical history was unremarkable, admitted to the emergency department due to stove poisoning and chest pain complaint.Conclusion: Although myocardial ischemia is an expected clinical condition in CO intoxications, STEMI is rare. In general, though underlying coronary heart disease is detected on angiography of patients with STEMI due to CO poisoning, in this rare condition, coronary artery anatomy can be completely normal

Keywords

Carbon monoxide, poisoning, myocardial infarction, angiography

References

• Lippi G, Rastelli G, Meschi T, Borghi L, Cervellin G. Pathophysiology, clinics, diagnosis and treatment of heart involvement in carbonmonoxide poisoning. Clin Biochem 2012; 45: 1278-85. [CrossRef]
• Fiorista F, Casazza F, Comolatti G. Silent myocardial infarction caused by acute carbon monoxide poisoning. G Ital Cardiol 1993;23: 583-7.
• Peers C, Steele DS. Carbonmonoxide: a vital signalling molecule and potent toxin in the myocardium. J Mol Cell Cardiol 2012; 52: 359-65. [CrossRef]
• Jang W, Park JH. Transient Left Ventricular Systolic Dysfunction Associated with Carbon Monoxide Toxicity. J Cardiovasc Ultrasound 2010; 18: 12-5. [CrossRef]
• Ciftçi O, Günday M, Calışkan M, Güllü H, Doğan R, Güven A, et al. Mild carbon monoxide poisoning impairs left ventricular diastolic function. Indian J Crit Care Med 2013; 17: 148-53. [CrossRef]
• Dallas ML, Yang Z, Boyle JP, Boycott HE, Scragg JL, Milligan CJ, et al. Carbon monoxide induces cardiac arrhythmia via induction of the late Na+ current. Am J Respir Crit Care Med 2012; 186: 648-56. [CrossRef]
• Akilli NB, Akinci E, Akilli H, Dundar ZD, Koylu R, Polat M, et al. A new marker for myocardial injury in carbon monoxide poisoning: T peak-T end. Am J Emerg Med 2013; 31: 1651-5. [CrossRef]
• Kao HK, Lien TC, Kou YR, Wang JH. Assessment of myocardial injury in the emergency department independently predicts the short-term poor outcome in patients with severe carbon monoxide poisoning receiving mechanical ventilation and hyperbaric oxygen therapy. Pulm Pharmacol Ther 2009; 22: 473-7. [CrossRef]
• Dziewierz A, Ciszowski K, Gawlikowski T, Rakowski T, Kleczyński P, Surdacki A, et al. Primary Angioplasty in Patient with St-Segment Elevation Myocardial Infarction in the Setting of Intentional Carbon Monoxide Poisoning. J Emerg Med 2013; 45: 831-4. [CrossRef]
• Kim S, Lim JH, Kim Y, Oh S, Choi WG. A case of acute carbon monoxide poisoning resulting in an ST elevation myocardial infarction. Korean circulation journal 2012; 42: 133-5. [CrossRef]
• McCabe MJ, Weston CF, Fraser AG. Acute myocardial infarction related to smoke inhalation and myocardial bridging. Postgrad Med J 1992; 68: 758-61. [CrossRef]
• Leach RM, Rees PJ, Wilmshurst P. Hyperbaric oxygen therapy. BMJ 1998; 317: 1140-3. [CrossRef]