Subclinical chronic left ventricular systolic dysfunction resulting from phosphine poisoning

Area of Science:

• Toxicology
• Cardiology
• Occupational Health

Background:

• Accidental exposure to phosphine, a fumigating agent, occurred on a cargo ship.
• Initial symptoms included fatigue, digestive issues, and severe outcomes like pulmonary edema in some crew members.
• Previous research indicates phosphine can induce left ventricular (LV) dysfunction.

Purpose of the Study:

• To investigate potential chronic cardiac consequences of acute phosphine poisoning.
• To assess long-term myocardial function in a survivor of significant phosphine exposure.
• To evaluate the utility of advanced echocardiographic techniques in detecting subclinical cardiac abnormalities.

Main Methods:

• Case report of a 32-year-old male cargo ship crew member exposed to phosphine.
• Clinical diagnosis included pneumonia, nephritis, hepatopathy, electrolyte imbalance, and leucopenia.
• Follow-up assessment at 4 months using standard echocardiography and two-dimensional speckle tracking echocardiography (2DSTE).

Main Results:

• Standard echocardiography revealed normal heart size and function 4 months post-exposure.
• Advanced 2DSTE analysis demonstrated depressed global longitudinal strain, indicating subclinical LV dysfunction.
• The patient was asymptomatic at the time of the follow-up examination.

Conclusions:

• Subclinical myocardial dysfunction following acute phosphine exposure can persist for months.
• This dysfunction may not be entirely reversible, even in asymptomatic individuals.
• Advanced quantitative echocardiography, specifically 2DSTE, is crucial for diagnosing persistent, subclinical LV longitudinal dysfunction after phosphine poisoning.