Very Late Stent Thrombosis in a Patient Presenting with Acute Carbon Monoxide Poisoning

Öz

Introduction: Carbon monoxide (CO), which is commonly referred to as the silent killer, can cause deleterious and unwanted cardiac effects. Some of these are arrhythmias, acute myocardial infarction (AMI), cardiogenic shock, heart failure, and pulmonary edema.Case Report: A 50-year-old man, complaining of dyspnea and chest pain, presented to the emergency room approximately half an hour after exposure to fire smoke. He had a history of anterior myocardial infarction 3 years previously and had been treated with a tacrolimus-eluting stent at that time. On admission, electrocardiography showed ST segment elevation in the leads D1, aVL, and V1–3, and ST segment depression in the reciprocal leads. The patient was transferred to the cardiac catheterization laboratory, and coronary angiography revealed stent thrombosis in the proximal part of the left anterior descending artery, causing 100% occlusion. The patient underwent successful balloon angioplasty and stenting. For the treatment of acute CO poisoning, he was administered oxygen. The patient’s condition continued to be stable, and he was discharged from the coronary intensive care unit.Conclusion: Patients who have undergone coronary stenting, particularly those in whom drug-eluting stents have been implanted, should be carefully investigated for AMI, stent thrombosis, or any other cardiac complications in the emergency room after CO poisoning

Anahtar Kelimeler

• Carbon monoxide poisoning, anterior wall myocardial infarction, drug-eluting stent

Kaynakça

1. Lippi G, Rastelli G, Meschi T, Borghi L, Cervellin G. Pathophysiology, clin- ics, diagnosis and treatment of heart involvement in carbon monoxide poisoning. Clin Biochem 2012; 45: 1278-85.[CrossRef ]
2. Dileo PA, Tucciarone M, Castro ER, Guerrero M. Late stent thrombosis secondary to carbon monoxide poisoning. Cardiovasc Revasc Med 2011; 12: 56-8. [CrossRef ]
3. Hsu PC, Lin TH, Su HM, Lee HC, Huang CH, Lai WT, et al. Acute carbon monoxide poisoning resulting in ST elevation myocardial infarction: a rare case report. Kaohsiung J Med Sci 2010; 26: 271-5. [CrossRef ]
4. Weaver LK. Clinical practice. Carbon monoxide poisoning. N Engl J Med 2009; 360: 1217-25. [CrossRef ]
5. Alonso JR, Cardellach F, Lopez S, Casademont J, Miro O. Carbon monox- ide specifically inhibits cytochrome c oxidase of human mitochondrial respiratory chain. Pharmacol Toxicol 2003; 93: 142-6. [CrossRef ]
6. Iheagwara KN, Thom SR, Deutschman CS, Levy RJ. Myocardial cyto- chrome oxidase activity is decreased following carbon monoxide ex- posure. Biochim Biophys Acta 2007; 1772: 1112-16. [CrossRef ]
7. Raub JA, Mathieu-Nolf M, Hampson NB, Thom SR. Carbon monoxide poisoning: a public health perspective. Toxicology 2000; 145: 1-14. [CrossRef ]
8. Nielsen VG, Arkebauer MR, Vosseller K. Redox-based thrombelasto- graphic method to detect carboxyhemefibrinogen-mediated hyperco- agulability. Blood Coagul Fibrinolysis 2011; 22: 657-61. [CrossRef ]

9. Grace TW, Platt FW. Subacute carbon monoxide poisoning. Another great imitator. JAMA 1981; 246: 1698-1700. [CrossRef ]