Asymptomatic Myocardial Injury in a Low Level of Carbon Monoxide Poisoning

Abstract

Carbon monoxide (CO) poisoning is an important cause of mortality and morbidity. Although measured in CO levels are not always correlated with clinical symptoms, neurological symptoms may present in lower CO levels, and cardiac signs and symptoms may occur in high CO levels. Low levels of CO exposure are very rare causes of myocardial injury. In this case presentation, we aimed to report on a patient who had a 20% level of CO and high troponin level without cardiac signs and symptoms. A 26-year-old male presented to the emergency department with headache, nausea, and vomiting. The initial electrocardiogram showed ST-segment depression of 1 mm in Lead II(II)-Lead III(III) Lead augmented vector foot (aVF) and ST-segment elevation in Lead I(I)Lead augmented vector left (aVL). The patient’s laboratory values were as follows: troponin I: 1.5 ng/mL and FCOHb: 20.7%. The first echocardiogram of the patient demonstrated global hypokinesia of the left ventricle. The coronary angiogram of the patient was normal. All patients considered to have CO poisoning should be evaluated with electrocardiograms, cardiac necrosis marker measurements, and an echocardiogram for myocardial injury regardless of the level of CO or the absence of cardiac symptoms and signs. (JAEM 2015; 14: 91-3)