Unlu M, Ozturk C, Demirkol S, Balta S, Malek A, Celik T, Iyisoy A
Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik-Ankara, Turkey
Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik-Ankara, Turkey.
Hum Exp Toxicol. 2016 Jan;35(1):101-5. doi: 10.1177/0960327115577542. Epub 2015 Mar 2.
ST segment elevation myocardial infarction (STEMI) due to coronary artery occlusion caused by intracoronary thrombosis in the setting of acute carbon monoxide (CO) poisoning is a very rare presentation. We present a case of intracoronary large and mobile thrombus formation after CO poisoning.
A previously healthy 50-year-old woman was referred for CO poisoning. She had chest pain after exposure to CO. Her initial mental status was preoccupied with chest pain. Her initial CO fraction was 28.1%, and initial laboratory data showed creatine kinase-myocardial isoenzyme of 134 U/L (upper limit 25 U/L) and troponin I of >50 ng/mL (upper limit 0.06 ng/mL). Electrocardiography was carried out on admission, revealing an ST segment elevation in the inferolateral leads. After initial evaluation, coronary angiography was performed and an intracoronary large mobile thrombus was seen in the proximal left anterior descending (LAD) artery with no significant stenosis. We administered tenecteplase with heparin. After the thrombolytic therapy, ST elevation in the inferolateral leads resolved. Repeat angiography was performed after 24 h; the thrombus in LAD had resolved. The patient was discharged after 5 days, with persistent Q wave in the inferior leads and mild hypokinesia of the inferoposterior wall suggesting myocardial injury.
We describe intracoronary thrombus formation induced by CO poisoning. Because intracoronary thrombus can result in myocardial infarction, its consideration following CO poisoning is important. Patients with CO poisoning who have symptoms of STEMI should be carefully evaluated with serial electrocardiograms, cardiac biomarkers, and an echocardiogram. When there is evidence of acute myocardial injury, a primer in coronary angiography can determine which patients could benefit from intervention.
在急性一氧化碳（CO）中毒情况下，因冠状动脉内血栓形成导致冠状动脉闭塞引起的ST段抬高型心肌梗死（STEMI）是一种非常罕见的表现。我们报告一例CO中毒后冠状动脉内形成巨大可移动血栓的病例。
一名既往健康的50岁女性因CO中毒前来就诊。她在接触CO后出现胸痛。其初始精神状态专注于胸痛。她的初始一氧化碳分数为28.1%，初始实验室数据显示肌酸激酶心肌同工酶为134 U/L（上限25 U/L），肌钙蛋白I>50 ng/mL（上限0.06 ng/mL）。入院时进行了心电图检查，显示下侧壁导联ST段抬高。初步评估后，进行了冠状动脉造影，发现左前降支（LAD）近端有一个冠状动脉内巨大可移动血栓，无明显狭窄。我们给予了替奈普酶联合肝素治疗。溶栓治疗后，下侧壁导联的ST段抬高消失。24小时后进行了重复血管造影；LAD内的血栓已溶解。患者在5天后出院，下壁导联持续存在Q波，下后壁轻度运动减弱，提示心肌损伤。
我们描述了CO中毒诱导的冠状动脉内血栓形成。由于冠状动脉内血栓可导致心肌梗死，因此在CO中毒后考虑到这一点很重要。有STEMI症状的CO中毒患者应通过连续心电图、心脏生物标志物和超声心动图进行仔细评估。当有急性心肌损伤的证据时，冠状动脉造影可以确定哪些患者可能从干预中获益。
