Gao Yu, Yang Jing, Ma Linlin, Zhang Yi, Li Zhuo, Wu Lianhua, Yang Lin, Wang Hongshi
Department of Hyperbaric Oxygen Medicine.
Department of Cardiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing.
Medicine (Baltimore). 2019 Apr;98(15):e15151. doi: 10.1097/MD.0000000000015151.
Acute myocardial infarction is a rare complication of carbon monoxide poisoning. there is often no chest pain and other typical manifestations. We report a patient with mild carbon monoxide poisoning who had acute dyspnea as the earliest symptom and was later diagnosed with non-ST elevation myocardial infarction (NSTEMI) and acute left heart failure.
A 73-year-old woman complained of dizziness and fatigue with shortness of breath after carbon monoxide intoxication.
This patient had a clear history of carbon monoxide poisoning, acute respiratory distress, bilateral lung dry and moist rale, chest X-ray showed bilateral pulmonary edema, Electrocardiograph indicated general depression of the ST segment of the leads in the chest, cardiac troponin I (CTNI) increased progressively, cardiac ultrasonography indicated abnormal ventricular wall movement, coronary angiography suggested left main trunk and 3-vessel lesions, suggesting diagnosis acute carbon monoxide poisoning, acute coronary syndrome, acute left heart failure.
She was treated with a high concentration of oxygen, an inhibitor of platelet aggregation (aspirin plus clopidogrel), an anticoagulant (low molecular weight heparin), an antimicrobial (ceftizoxime), an expectorant (mucosolvan), diuresis (furosemide and spironolactone), and myocardial support (Metoprolol). Coronary angiography and stent placement were performed 8 days later.
On the 10th day after onset of the condition, echocardiography was performed, which showed that cardiac function was improved. Mild segmental wall motion abnormality was observed on echocardiography. After 14 days, the patient had recovered well and was discharged without chest tightness, chest pain, dizziness, headache, or unresponsiveness.
This case suggests that the symptoms of carbon monoxide poisoning are complex and diverse. It can be manifested as a primary hypoxic symptom, or cause the exacerbation of underlying diseases due to hypoxia. Therefore, patients with carbon monoxide poisoning should actively seek comprehensive cardiac examination to ensure early diagnosis. Whenever necessary, coronary angiography and stent implantation should be performed to improve the likelihood of the patient's survival.
急性心肌梗死是一氧化碳中毒的一种罕见并发症。通常没有胸痛及其他典型表现。我们报告一例轻度一氧化碳中毒患者，最早出现的症状是急性呼吸困难，随后被诊断为非ST段抬高型心肌梗死（NSTEMI）和急性左心衰竭。
一名73岁女性在一氧化碳中毒后出现头晕、乏力及呼吸急促。
该患者有明确的一氧化碳中毒病史，急性呼吸窘迫，双肺干湿啰音，胸部X线显示双侧肺水肿，心电图提示胸前导联ST段普遍压低，心肌肌钙蛋白I（CTNI）逐渐升高，心脏超声提示室壁运动异常，冠状动脉造影提示左主干及三支血管病变，提示诊断为急性一氧化碳中毒、急性冠状动脉综合征、急性左心衰竭。
给予高浓度吸氧、血小板聚集抑制剂（阿司匹林加氯吡格雷）、抗凝剂（低分子肝素）、抗菌药物（头孢唑肟）、祛痰剂（沐舒坦）、利尿（呋塞米和螺内酯）及心肌支持治疗（美托洛尔）。8天后进行冠状动脉造影及支架置入术。
发病第10天进行心脏超声检查，结果显示心功能改善。心脏超声检查观察到轻度节段性室壁运动异常。14天后，患者恢复良好，出院时无胸闷、胸痛、头晕、头痛或反应迟钝。
该病例提示一氧化碳中毒症状复杂多样。可表现为原发性缺氧症状，或因缺氧导致基础疾病加重。因此，一氧化碳中毒患者应积极进行全面的心脏检查以确保早期诊断。必要时应进行冠状动脉造影及支架植入术，以提高患者的生存几率。
