Acute myocardial infarction related to smoke inhalation and 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.