Myocardial Rupture following Carbon Monoxide Poisoning.

Gabija Dragelytė,Robertas Badaras,Jūris Plenta,Algimantas Jasulaitis,Romas Raudys,Sigitas Chmieliauskas,Tomas Jovaiša

doi:10.1155/2014/281701

Abstract

We present the first case of severe cardiotoxicity of carbon monoxide leading to myocardial rupture and fatal outcome. 83-year-old woman was hospitalized 4 hours after the fire in her house with no respiratory or cardiac symptoms. After two days, she has suffered sudden collapse leading to cardiac arrest. Postmortem examination revealed intramural haemorrhage with myocardial rupture at the apex of the left ventricle. Minimal stenosis was noted in the proximal coronary arteries with no evidence of distal occlusion or any other long-standing heart disease. This case supports recommendations for targeted cardiovascular investigations in cases of CO poisoning.

Highlights

We present the first case of severe cardiotoxicity of carbon monoxide leading to myocardial rupture and fatal outcome. 83-year-old woman was hospitalized 4 hours after the fire in her house with no respiratory or cardiac symptoms
Her condition remained stable and she did not require any other organ support for the following 24 hours. 12-lead ECG was done on admission to intensive care unit (ICU) and continuous ECG monitoring in standard lead II was used; it did not demonstrate any evidence of myocardial ischaemia until the following day when patient has suffered sudden cardiovascular collapse
It is most likely that primary causative factor of myocardial rupture was toxicity of CO

Summary

Case Presentation

83-year-old woman was hospitalized 4 hours after the fire in her house, which she attempted to extinguish herself. Oxygen saturation was maintained above 95% with inspired oxygen concentration of up to 60% Her condition remained stable and she did not require any other organ support for the following 24 hours. 12-lead ECG was done on admission to ICU and continuous ECG monitoring in standard lead II was used; it did not demonstrate any evidence of myocardial ischaemia until the following day when patient has suffered sudden cardiovascular collapse. She became progressively hypotensive and suffered asystolic cardiac arrest and all resuscitation attempts were unsuccessful. 6 hours after the signs of ischaemia; in this case, fulminant progression of cardiac pathology did not allow us to perform the tests

Postmortem Report

Findings

Discussion