Carbon monoxide (CO) poisoning is the most common cause of death from poisoning in the United States. Cardiovascular complications and their contribution to acute outcomes are yet to be defined.
We retrospectively reviewed the cardiovascular manifestations in 47 patients presenting with CO poisoning during the period from January 2009 to September 2011 in St Vincent Charity Medical Center, a regional center for Co poisoning treatment. Baseline patients data, electrocardiograms (EKG, s), full lab results and echocardiograms were obtained from patients’ charts.
The mean age was 49.3 with 72% men. The mean hospital stay was 2.6 days. The average carboxyhemoglobin (COHb) level was 24.9. Intentional poisoning was present in 20% of patients, 19% had lost their consciousness (LOC) and 19.6% had to be intubated. Cardiovascular risk factors in our patient population included 8.5% diabetic, 36.2% hypertensive and 6% dyslipidemic, 32% were smokers and 4% had a family history of premature coronary artery disease. Obesity was present in 18.8% of our patients with 4% having documented history of CAD and 14 % had used cocaine prior to admission. Troponin I was found to be more than 0.2 ng/mL in 36.6 % of patients and more than 1 ng/mL in 16.8% of patients. Ischemic EKG changes were found in 4 % of patients. Corrected QT interval was prolonged (>440 msec) in 67.5% of patients. Echocardiogram was done in 11% of patients and 4% had depressed left ventricular ejection fraction that reversed to normal upon discharge. Treatment with hyperbaric oxygen (HBO) treatment was done in 91.6%and 4% died by anoxic brain injury that was unrelated to their cardiac status. There was no correlation between COHb level and troponins or QTc(r=0.2 and 0.02 respectively)). LOC and intubation were the main predictors of significant myocardial injury (troponins >1 ng/mL).
Myocardial damage in patients presenting with CO poisoning is common and manifested by increased troponins and prolonged QTc . There is no correlation between COHb level and myocardial injury. In these patients, LOC and intubation are the only two significant predictors of myocardial injury which is usually transient and can be reversed with urgent HBO therapy. Further cardiac evaluation with non invasive and invasive procedures should be reserved for patients who don’t respond to HBO.
To cite this abstract:Ibrahim A, Tiu H, Shaheen K, Alraies M, Amro O, Mayasy S, Buriev U. Myocardial Damage in Carbon Monoxide Poisoning: Reversible or Irreversible?. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97668. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/myocardial-damage-in-carbon-monoxide-poisoning-reversible-or-irreversible/. Accessed April 4, 2020.