Canakkale Onsekiz Mart University Faculty of Medicine, Department of Cardiology, Canakkale, Turkey.
Eskisehir State Hospital, Department of Cardiology, Eskişehir, Turkey.
Prehosp Disaster Med. 2019 Dec;34(6):677-680. doi: 10.1017/S1049023X19004898. Epub 2019 Oct 9.
Carbon monoxide (CO) poisoning is the most common cause of death and injury among all poisonings. Myocardial injury is detected in one-third of CO poisonings. In this Case Report, a previously healthy 41-year-old man was referred for CO poisoning. The initial electrocardiogram (ECG) showed 1mm ST segment elevation in leads DII, DIII, and aVF. As the patient did not describe chest pain and had no cardiac symptoms, ECG was repeated 10 minutes later and it was seen that ST segment elevation disappeared. As the patient had a transient ST segment elevation and elevated high-sensitive Tn-T (HsTn-T), the patient was transferred to the coronary angiography laboratory. The patient's left coronary system was normal, but a thrombus image narrowing the lumen by approximately 60% was observed in the right coronary artery. Intravenous tirofiban was administered for 48 hours. Control coronary angiography showed continuing thrombus formation and a bare metal stent was successfully implanted. This is the first reported case with transient ST segment elevation associated with acute coronary thrombus caused by CO poisoning. It may be recommended that patients with CO poisoning should be followed-up with a 12-lead ECG monitor or 24-hour ECG Holter monitoring, even if they show no cardiac symptoms and echocardiography shows no wall motion abnormality. Early coronary angiography upon detection of such dynamic ECG changes in these recordings as ST segment elevation can reduce the risk of myocardial infarction (MI) and mortality in these patients.
一氧化碳（CO）中毒是所有中毒中最常见的致死和致残原因。三分之一的 CO 中毒患者会出现心肌损伤。在本病例报告中，一名既往健康的 41 岁男性因 CO 中毒被转介。初始心电图（ECG）显示 DII、DIII 和 aVF 导联 1mm ST 段抬高。由于患者未描述胸痛且无心脏症状，10 分钟后重复 ECG，发现 ST 段抬高消失。由于患者存在短暂性 ST 段抬高和高敏肌钙蛋白 T（HsTn-T）升高，将患者转至冠状动脉造影实验室。患者的左冠状动脉系统正常，但在右冠状动脉中观察到血栓图像导致管腔狭窄约 60%。静脉内替罗非班给药 48 小时。冠状动脉造影控制显示持续血栓形成，并成功植入裸金属支架。这是首例报告的与 CO 中毒引起的急性冠状动脉血栓形成相关的短暂性 ST 段抬高的病例。建议对 CO 中毒患者进行 12 导联 ECG 监测或 24 小时动态心电图 Holter 监测，即使他们没有心脏症状且超声心动图显示壁运动异常。在这些记录中发现 ST 段抬高等动态 ECG 变化时，早期进行冠状动脉造影可以降低这些患者心肌梗死（MI）和死亡率的风险。
