CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 2, March/April 2011
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Reversible myocardial stunning due to carbon monoxide
exposure
H FOTBOLCU, O INCEDERE, RB BAKAL, AC TANALP, MA ASTARCIOGLU, I DINDAR
Abstract
We report on a 37-year-old patient who suffered from
myocardial stunning after exposure to carbon monoxide,
despite having normal coronary arteries. As myocardial
ischaemia may be asymptomatic in these patients, close
monitoring with serial electrocardiography and of serum
cardiac enzymes and troponins is recommended.
Keywords:
carbon monoxide poisoning, reversible myocardial
stunning, electrocardiogram
Submitted 30/12/09, accepted 29/3/10
Cardiovasc J Afr
2011;
22
: 93–95
DOI: CVJ-21.021
Carbon monoxide (CO) poisoning may disturb the normal
human biochemical respiratory cascade, causing ischaemic
injury to tissues and cells. Such injuries to human cells have been
ubiquitously documented. Carbon monoxide poisoning is rarely
a cause of myocardial infarction.
CO has a higher affinity to haemoglobin than oxygen. It
attaches to haemoglobin (Hb) and blocks its capacity to carry
oxygen. It has been suggested that carboxyhaemoglobin causes
myocardial infarction by severe generalised tissue hypoxia and
a direct toxic effect on the myocardial mitochondria in patients
with or without pre-existing coronary artery disease (CAD). We
report on a 37-year-old woman who had reversible myocardial
stunning without CAD, after exposure to CO.
Case report
A 37-year-old woman was admitted to our emergency depart-
ment with altered consciousness as a consequence of acute
domestic CO poisoning from a malfunctioning stove. She had no
history of tobacco use, hypertension or CAD. The rescue squad
initiated artificial respiration before arrival at the emergency
room. On admission, her body temperature was 37.5ºC, pulse
rate was 146 beats per minute (bpm), respiratory rate was 24
breaths per min, and blood pressure was 169/72 mmHg.
The patient was semi-comatose but the remainder of the
physical examination was normal. The electrocardiogram (ECG)
done on admission showed sinus tachycardia with a rate of 125
bpm. The initial blood tests, including serum cardiac markers
and liver-function tests were within normal limits, except for
a mildly elevated white blood cell count (14 500 cells/
m
l). The
arterial blood gas analysis showed normal values and the serum
Göztepe Medical Park Hospital, Istanbul, Turkey
H FOTBOLCU, MD,
O INCEDERE, MD
RB BAKAL, MD
MA ASTARCIOGLU, MD
I DINDAR, MD
Medicana International Hospital, Ankara, Turkey
AC TANALP, MD
