Carbon monoxide poisoning and myocardial ischemia in patients with burns

Carbon monoxide poisoning is a well-known problem in patients with burns. A retrospective 11-year chart review was undertaken to determine the incidence of myocardial injury after carbon monoxide poisoning. Of the 1533 consecutive admissions from July 1, 1979 to June 30, 1990, 18 patients had carboxyhemoglobin levels of greater than or equal to 10% on admission. Five of these patients were found to have electrocardiographic changes that were indicative of myocardial injury. (Three also had elevated levels of creative kinase-MB). Four of five patients with electrocardiographic changes were operated on successfully with the use of perioperative invasive monitoring. None of the 18 patients had congestive heart failure or cardiac dysrhythmias during their hospital course. These data suggest that myocardial damage can result from acute carbon monoxide poisoning, and appropriate screening is indicated for the detection of such injuries.