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Acute myocardial infarction related to smoke inhalation and myocardial bridging
M J McCabe1, C F Weston, A G Fraser
1Department of Cardiology, University Hospital of Wales, Health Park, Cardiff, UK.
Insights
Smoke inhalation from a house fire triggered acute myocardial infarction in a young woman. This suggests carbon monoxide exposure can cause heart attacks in individuals with myocardial bridging.
Area of Science:
- Cardiology
- Toxicology
- Emergency Medicine
Background:
- Acute myocardial infarction (AMI) typically occurs in older individuals with established coronary artery disease.
- Myocardial bridging, a congenital anomaly where a coronary artery segment tunnels through heart muscle, is an increasingly recognized finding.
- Carbon monoxide (CO) poisoning is a common cause of morbidity and mortality, primarily affecting oxygen delivery to tissues.
Observation:
- A previously healthy 26-year-old woman presented with acute anterior myocardial infarction and ventricular fibrillation after smoke exposure during a house fire.
- Left ventriculography confirmed anterior infarction.
- Coronary arteriography revealed normal coronary arteries except for myocardial bridging over the left anterior descending artery.
Findings:
- The patient's presentation of AMI, despite normal coronary arteries apart from myocardial bridging, is unusual.
- The temporal association between smoke exposure (implying carbon monoxide inhalation) and myocardial infarction suggests a causal link.
- This case highlights a potential mechanism where CO toxicity exacerbates ischemia in the setting of myocardial bridging.
Implications:
- Carbon monoxide inhalation may precipitate acute myocardial infarction in individuals with underlying myocardial bridging.
- This case expands the understanding of cardiovascular complications associated with carbon monoxide exposure.
- Further research is warranted to elucidate the precise pathophysiological mechanisms linking CO exposure, myocardial bridging, and ischemic events.
Abstract:
A previously healthy 26 year old woman who was exposed to smoke during a house fire developed acute anterior myocardial infarction complicated by ventricular fibrillation. Subsequent left ventriculography confirmed anterior infarction, but coronary arteriography was normal apart from myocardial bridging over a segment of the left anterior descending artery. The development of acute myocardial infarction in this patient suggests that, in the presence of bridging, carbon monoxide inhalation may cause regional infarction.