J Cardiovasc Ultrasound.  2010 Mar;18(1):12-15. 10.4250/jcu.2010.18.1.12.

Transient Left Ventricular Systolic Dysfunction Associated with Carbon Monoxide Toxicity

• Jang WI
• Park JH

• KMID: 1457199
• DOI: http://doi.org/10.4250/jcu.2010.18.1.12

Abstract

Carbon monoxide (CO) is one of well known chemical asphyxiants which cause tissue hypoxia with prominent neurologic and cardiovascular injury. Cardiac dysfunction after CO poisoning can be presented as two clinical patterns. One is transient global left ventricular (LV) dysfunction and the other is LV dysfunction with regional wall motion abnormalities. In this case report, we present a case with transient LV systolic dysfunction caused by intentional exposure to CO. After conservative treatment including high concentration of oxygen, the patient recovered completely without any complication.

Keyword

Carbon monoxide; Left ventricular dysfunction; Hypoxia

MeSH Terms

Anoxia
Carbon
Carbon Monoxide
Humans
Oxygen
Ventricular Dysfunction, Left
Carbon
Carbon Monoxide
Oxygen

Figure

• 

  Fig. 1 The chest X-ray checked on the admission demonstrates mild cardiomegaly and pulmonary edema (A). After three days of treatment, the cardiac size is normalized and pulmonary edema is disappeared (B).

• 

  Fig. 2 The echocardiogram performed at admission shows global hypokinesia and severe left ventricular systolic dysfunction with ejection fraction of 33% (A: end-diastole, B: end-systole). With four days of conventional treatment including high concentration of oxygen, follow up echocardiography reveals normalized left ventricular function without wall motion abnormalities (C: end-diastole, D: end-systole).

Reference

1. Gandini C, Castoldi AF, Candura SM, Locatelli C, Butera R, Priori S, Manzo L. Carbon monoxide cardiotoxicity. J Toxicol Clin Toxicol. 2001. 39:35–44.

2. Ernst A, Zibrak JD. Carbon monoxide poisoning. N Engl J Med. 1998. 339:1603–1608.

3. Omaye ST. Metabolic modulation of carbon monoxide toxicity. Toxicology. 2002. 180:139–150.

4. Raub JA, Mathieu-Nolf M, Hampson NB, Thom SR. Carbon monoxide poisoning--a public health perspective. Toxicology. 2000. 145:1–14.

5. Henry CR, Satran D, Lindgren B, Adkinson C, Nicholson CI, Henry TD. Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning. JAMA. 2006. 295:398–402.

6. Marius-Nunez AL. Myocardial infarction with normal coronary arteries after acute exposure to carbon monoxide. Chest. 1990. 97:491–494.

7. Anderson RF, Allensworth DC, DeGroot WJ. Myocardial toxicity from carbon monoxide poisoning. Ann Intern Med. 1967. 67:1172–1182.

8. McMeekin JD, Finegan BA. Reversible myocardial dysfunction following carbon monoxide poisoning. Can J Cardiol. 1987. 3:118–121.

9. Allred EN, Bleecker ER, Chaitman BR, Dahms TE, Gottlieb SO, Hackney JD, Pagano M, Selvester RH, Walden SM, Warren J. Shortterm effects of carbon monoxide exposure on the exercise performance of subjects with coronary artery disease. N Engl J Med. 1989. 321:1426–1432.

10. Thompson N, Henry JA. Carbon monoxide poisoning: poisons unit experience over five years. Hum Toxicol. 1983. 2:335–338.

11. Balzan MV, Cacciottolo JM, Mifsud S. Unstable angina and exposure to carbon monoxide. Postgrad Med J. 1994. 70:699–702.

12. Ebisuno S, Yasuno M, Yamada Y, Nishino Y, Hori M, Inoue M, Kamada T. Myocardial infarction after acute carbon monoxide poisoning: case report. Angiology. 1986. 37:621–624.

13. Diltoer MW, Colle IO, Hubloue I, Ramet J, Spapen HD, Nguyen N, Huyghens LP. Reversible cardiac failure in an adolescent after prolonged exposure to carbon monoxide. Eur J Emerg Med. 1995. 2:231–235.

14. Satran D, Henry CR, Adkinson C, Nicholson CI, Bracha Y, Henry TD. Cardiovascular manifestations of moderate to severe carbon monoxide poisoning. J Am Coll Cardiol. 2005. 45:1513–1516.

15. Adams JE 3rd, Sicard GA, Allen BT, Bridwell KH, Lenke LG, Dávila-Román VG, Bodor GS, Ladenson JH, Jaffe AS. Diagnosis of perioperative myocardial infarction with measurement of cardiac troponin I. N Engl J Med. 1994. 330:670–674.