An unusual CO-conspirator in a case of acute coronary syndrome

Carbon monoxide (CO) poisoning is a common cause of morbidity and mortality that exerts its physiological effects by competition with molecular oxygen. Therefore, tissues that extract a high fraction of oxygen from circulating blood are at high risk for injury due to CO toxicity. While neurological complications of CO poisoning have been well described, cardiac damage secondary to CO poisoning also occurs, but has been less frequently reported. We present the case of a young man with CO poisoning who had elevated cardiac biomarkers, a regional wall motion abnormality, and was found to have obstructive coronary disease. Evidence of myocardial necrosis in the setting of CO toxicity should prompt consideration of an evaluation for coronary artery disease, particularly among those with risk factors.