Acute Coronary Syndrome Induced by Carbon Monoxide Intoxication: A Case Report

Carbon monoxide (CO) intoxication is the most frequent etiology of toxicological morbidity and mortality in the world. If the neurological manifestations are in the foreground, then cardiovascular signs of myocardial damage by necrosis are possible, which can result in angina, an acute coronary syndrome followed by myocardial stupor, collapse or even cardiac arrest. We report a case of CO intoxication inducing an acute coronary syndrome without ST elevation in an elderly diabetic patient with no coronary artery disease history. Diagnosis: This patient presented a CO intoxication after an accidental exposure; the electrocardiogram showed a depressed ST segment of the inferior and apico-lateral leads; cardiac enzyme troponins gradually increased. Echocardiography showed a preserved systolic function with a disorder of the heart wall motions. Coronary angiography revealed significant lesions of the proximal left anterior descending artery (LAD) and the first marginal evoking a diagnosis of acute coronary syndrome induced by CO intoxication. Interventions: His management consisted of the administration of hyperbaric oxygen therapy, a platelet aggregation inhibitor (aspirin plus clopidogrel), an anticoagulant (low molecular weight heparin) and myocardial support (Bisoprolol). Coronary angiography and the placement of two active stents were performed after 24hrs onset diagnosis. Results: The patient had a good clinical outcome under hyperbaric oxygen therapy, complete revascularization of the angiographic lesions which showed improvement in cardiac function and a slight improvement of heart wall motion on echocardiography performed on the 5th day. After 6 days, the patient had recovered well and was discharged from the hospital without chest discomfort, dizziness or headache. Lecture: This case suggests that the symptoms of carbon monoxide intoxication are complex and diverse. This can manifest as a primary hypoxic symptom or cause an exacerbation of underlying diseases due to hypoxia. Therefore, patients with carbon monoxide intoxication should actively seek a comprehensive cardiac examination to ensure early diagnosis. Whenever necessary, coronary angiography and stent implantation should be performed to improve the patient's chances of survival.