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CLINICAL RESEARCH: CARBON MONOXIDE POISONING

Cardiovascular Manifestations of Moderate to Severe Carbon Monoxide Poisoning

Daniel Satran, MD^_*, Christopher R. Henry, BS, Cheryl Adkinson, MD, Caren I. Nicholson, RN, Yiscah Bracha, MS and Timothy D. Henry, MD^,_*

^_* Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.

Manuscript received November 4, 2004; revised manuscript received January 19, 2005, accepted January 25, 2005.

^_* Reprint requests and correspondence: Dr. Timothy D. Henry, Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 40, Minneapolis, Minnesota 55407. (Email: henry003{at}umn.edu).

OBJECTIVES: We describe the cardiovascular manifestations of carbon monoxide (CO) poisoning.

BACKGROUND: Carbon monoxide poisoning is a common cause of toxicologic morbidity and mortality. Although the neurologic sequelae of CO poisoning have been well described, the cardiovascular consequences are limited to isolated case reports.

METHODS: We reviewed the cardiovascular manifestations of 230 consecutive patients treated for moderate to severe CO poisoning in the hyperbaric oxygen chamber at Hennepin County Medical Center (HCMC), a regional center for treatment of CO poisoning.

RESULTS: The mean age was 47.2 years with 72% men. Ischemic electrocardiogram (ECG) changes were present in 30% of patients, whereas only 16% had a normal ECG. Cardiac biomarkers (creatine kinase-MB fraction or troponin I) were elevated in 35% of patients. In-hospital mortality was 5%.

CONCLUSIONS: Cardiovascular sequelae of CO poisoning are frequent, with myocardial injury assessed by biomarkers or ECG in 37% of patients. Patients admitted to the hospital with CO poisoning should have a baseline ECG and serial cardiac biomarkers.

Abbreviations and Acronyms   CAD = coronary artery disease   CO = carbon monoxide   COHb = carboxyhemoglobin   ECG = electrocardiogram   GCS = Glasgow Coma Scale   HBO2 = hyperbaric oxygen   HCMC = Hennepin County Medical Center   MI = myocardial infarction   WMA = wall motion abnormality

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