JELLAD A , BEN AMEUR W, ANTIT S , HERBEQUE B , ZAKHAMA L , BEN YOUSSEF S

Cardiology, Internal Security Forces Hospital, Tunis, Tunisia

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Background: Carbon monoxide poisoning is a medical emergency requiring immediate treatment since it can induce serious neurological and cardiac complications. Major deleterious effect of heavy exposure to carbon monoxide is cellular decreased oxygen supply leading to localised ischemia and then altered consciousness and heart infarction.

Case report: A 30-year-old woman with no particular history, admitted to the emergency service after heavy exposure to carbon monoxide.

The circumstances of the accident dates back to 30 minutes before admission , when she was discoverded unconscious in a closed area at home.On arrival , physical examination revealed disorientation , agitation and bilateral reflexes abolition with a relatively hemodynamic and repiratory stable state . The initial electrocardiographic findings revealed sinus tachycardia with a heart heart rate of approximately 130/min, T wave inversion in inferior and lateral leads. Laboratory tests showed elevation of cardiac enzymes levels (troponin T =0.5ng/ml; pick=9.5ng/ml) and CPK-MB =5117 ng/ml). No abnormalities were detected on chest radiography. Transthoracic Echocardiography found moderate hypokinesia of medium and basal segment of the inferoseptal wall with a preserved left ventricular ejection fraction ( LVEF =65 %) and coronary computed tomography ( CT) angiography performed to rule out coronary artery disease revealed normal coronary artery.

The patient was put in the emergency under hyperbaric oxygen and then under hight concentration oxygen mask with hyper hydration session. In tandem, conventional anti – ischemic treatment was induced as soon as cardiac abnormalities were detected. The patient was discharged without any complication and there have been no clinical features of cardiac comlications after six months of follow-up.

Discussion: Myocardial infarction rarely occurs after carbon monoxide poisoning. Whereas, once happened, it remains a major predictor factor of morbi-mortality .Biological and electro-physiologic cardiac exploration should be performed systematically for any patient admitted for carbon monoxide poisoning.