Clinical and scintigraphic (99mTc-MIBI SPECT) heart evaluation in young acutely carbon monoxide poisoned patients.

The results of myocardial (99mTc-MIBI SPECT) perfusion scintigraphy according to clinical evaluation, ECG, biochemical factors of necrosis and indicators of carbon monoxide (CO) poisoning severity are described in the paper. Under examination there were 88 young (mean age 26 +/- 8.5) acutely CO poisoned patients without previous cardiac illness history, treated at the Department of Clinical Toxicology Jagiellonian University Medical College in Krakow in 1996 to 2002. Measurement of COHb level, blood lactate concentration, duration of exposure and ECG examination were performed on admission. The enzymes activity ALT, AST, CK, MB-CK, was evaluated after 24-48 h. The severity of CO poisoning was estimated basing on age, duration of exposure, COHb level, blood lactate concentration and the patient neurological state on admission. 99mTc-MIBI SPECT was performed on days 1 to 5 post admission. The abnormalities in scintigraphic scans were assessed according to arbitrary accepted scale (0-IV). Conventional biomarkers creatine kinase, ALT and AST were insufficient for evaluation the heart injury in CO cutely poisoned patients. A statistically significant differences in the blood lactate concentration with regard to degree of scintigraphic changes have been observed. The ECG curves monitored from admission to discharge were analyzed in the study. Tachycardia was observed in all the patients but no statistically significant differences were found between the subgroups divided according to the degree of scintigraphic scans. Conductivity disturbances were detected mainly in patients qualified to higher then the first degree of scintigraphic changes. ECG signs of myocardial ischemia were the most frequent in patients with biggest pathological changes in 99mTc-MIBI scans. The changes in 99mTc-MIBI SPECT were observed in the majority of acutely CO poisoned patients. The mutual dependence of patient's condition based on neurological symptoms, carbon monoxide poisoning severity scoring and the degree of scintigraphy changes was found. The examination performed indicate that 99mTc-MIBI SPECT scintigraphy can be method of choice for evaluation the heart injury in patients after acute CO intoxication.