Carbon monoxide and ST-elevation myocardial infarction: case reports

Area of Science:

• Cardiology
• Toxicology
• Emergency Medicine

Background:

• Myocardial infarction with ST-segment elevation (STEMI) is a critical cardiac event.
• Carbon monoxide (CO) poisoning is a common environmental toxin with diverse clinical manifestations.
• The association between CO poisoning and STEMI is infrequently reported in medical literature.

Observation:

• Two cases are presented: a 62-year-old woman with chest pain and a 62-year-old man who fainted, both with confirmed CO exposure and ECG findings of ST elevation.
• Both patients presented to the emergency department (ED) with symptoms suggestive of acute coronary syndrome following CO exposure.
• The male patient experienced neurological deficits after initial ED treatment and return home, with paramedics detecting high CO levels.

Findings:

• Both patients received hyperbaric oxygen therapy (HBOT) early in their presentation.
• Management strategies for this rare combination of conditions are not well-established due to limited case reports.
• Interventional cardiology consultation and consideration for percutaneous coronary intervention (PCI) are recommended for STEMI secondary to CO poisoning, guided by ECG and echocardiography.

Implications:

• Rapid cardiac intervention, including angioplasty or stenting, should be considered in cases of CO poisoning-induced STEMI.
• Hyperbaric oxygen therapy may play a therapeutic role, leveraging its known benefits for myocardial ischemia and injury.
• Further research and case reporting are needed to establish evidence-based guidelines for managing CO poisoning-associated STEMI.