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Transient ST Segment Elevation Caused by Intracoronary Thrombus after Acute Carbon Monoxide Poisoning

Published online by Cambridge University Press:  09 October 2019

Ercan Akşit Open the ORCID record for Ercan Akşit [Opens in a new window] ,
Özge Turgay Yildirim Open the ORCID record for Özge Turgay Yildirim [Opens in a new window] ,
Fatih Aydin ,
Okan Bardakci  and
Ayşe Hüseyınoğlu Aydin
Ercan Akşit*
Affiliation:
Canakkale Onsekiz Mart University Faculty of Medicine, Department of Cardiology, Canakkale, Turkey
Özge Turgay Yildirim
Affiliation:
Eskisehir State Hospital, Department of Cardiology, Eskişehir, Turkey
Fatih Aydin
Affiliation:
Eskisehir State Hospital, Department of Cardiology, Eskişehir, Turkey
Okan Bardakci
Affiliation:
Canakkale Onsekiz Mart University Faculty of Medicine, Department of Emergency Service, Canakkale, Turkey
Ayşe Hüseyınoğlu Aydin
Affiliation:
Eskisehir State Hospital, Department of Cardiology, Eskişehir, Turkey
*
Correspondence: Ercan Akşit Barbaros Street Terzioglu Campus B Block No: 4 Onsekiz Mart University Faculty of Medicine Department of Cardiology Canakkale/Turkey E-mail: [email protected]
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Abstract

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.

Keywords

angioplastycarbon monoxidecoronary thrombosismyocardial infractionpoisoning
Type
Case Report
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 6 , December 2019 , pp. 677 - 680
Copyright
© World Association for Disaster and Emergency Medicine 2019 

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