Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Hum Exp Toxicol. 2013 Nov;32(11):1193-6. doi: 10.1177/0960327112472991. Epub 2013 Jan 28.
Carbon monoxide (CO) is one of the leading causes of poisoning; it inhibits oxygen delivery, subsequently causing ischemic changes and ultimately death by multiorgan failure. Furthermore, thromboembolic episodes due to CO poisoning have been reported. However, intracardiac thrombus formation following exposure to CO has been very rarely described. Here, a case of right atrial large thrombus formation after CO poisoning is presented.
A previously healthy 24-year-old woman was referred for CO poisoning. She has attempted suicide, and her initial mental status was drowsy with focal memory loss. Her initial CO fraction was 16%, and initial laboratory data showed creatinine kinase-myocardial bound of 90.6 ng/mL (upper limit 5 ng/mL) and troponin I of 1.899 ng/mL (upper limit 1.5 ng/mL). A transthoracic echocardiography was performed 24 h after the accident, revealing a 30 15 mm nodular echogenic mass in the right atrium. Anticoagulation with low-molecular-weight heparin was started along with hyperbaric oxygen therapy. After 7 days of heparinization, the large thrombus in right atrium had resolved.
This report describes an intracardiac thrombus formation induced by CO poisoning. Because intracardiac thrombus can result in pulmonary embolism and cerebral embolic infarction, its consideration following CO poisoning is important.
一氧化碳（CO）是中毒的主要原因之一；它抑制氧气输送，随后导致缺血性改变，最终因多器官衰竭而死亡。此外，已有 CO 中毒引起的血栓栓塞事件的报道。然而，暴露于 CO 后发生的心脏内血栓形成极为罕见。在此，报告 1 例 CO 中毒后右心房大血栓形成的病例。
一名既往健康的 24 岁女性因 CO 中毒被转介。她试图自杀，最初的精神状态为嗜睡伴局灶性记忆丧失。她的初始 CO 分数为 16%，初始实验室数据显示肌酸激酶-心肌结合物为 90.6ng/mL（上限为 5ng/mL），肌钙蛋白 I 为 1.899ng/mL（上限为 1.5ng/mL）。事故发生后 24 小时进行了经胸超声心动图检查，显示右心房有一个 30×15mm 的结节状回声团块。开始用低分子肝素进行抗凝治疗，并进行高压氧治疗。肝素化 7 天后，右心房的大血栓已溶解。
本报告描述了 CO 中毒引起的心脏内血栓形成。由于心脏内血栓可导致肺栓塞和脑栓塞性梗死，因此 CO 中毒后应考虑到这一点。
