J Cardiovasc Ultrasound.  2011 Jun;19(2):83-86. 10.4250/jcu.2011.19.2.83.

A Case Report of Carbon Monoxide Poisoning Induced Cardiomyopathy Complicated with Left Ventricular Thrombus

• Lee SJ
• Kang JH
• Kim NY
• Baek IW
• Park MY
• Shim BJ
• Koh YS
• Shin WS
• Lee JM
• Jeon HK

• KMID: 1980356
• DOI: http://doi.org/10.4250/jcu.2011.19.2.83

Abstract

The heart and the brain, most oxygen-dependent organs, may be severely affected after carbon monoxide (CO) exposure. CO induced cardiotoxicity may occur as a consequence of moderate to severe CO poisoning, including angina attack, myocardial infarct, arrhythmias, and heart failure. We present a rare case of CO poisoning induced cardiomyopathy with left ventricular (LV) thrombus. It is thought that LV thrombus may have been caused severely decreased LV function with dyskinesis. After short-term anticoagulant therapy, echocardiography findings revealed complete recovery of LV dyskinesis and resolution of LV thrombus.

Keyword

Cardiomyopathy; Left ventricular thrombus; Carbon monoxide

MeSH Terms

Arrhythmias, Cardiac
Brain
Carbon
Carbon Monoxide
Carbon Monoxide Poisoning
Cardiomyopathies
Echocardiography
Heart
Heart Failure
Myocardial Infarction
Thrombosis
Carbon
Carbon Monoxide

Figure

• 

  Fig. 1 The echocardiogram performed at admission reveals akinesis at the apex of LV and LV ejection fraction of less than 30%. A: End-diastole. B: End-systole. LV: left ventricle.

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  Fig. 2 A: Transthoracic echocardiogram demonstrates a 12 × 10 mm sized left ventricular thrombus at the apex on apical 4-chamber and short axis views (arrowhead). B: Complete resolution of the left ventricular thrombus is observed at the apex of LV on apical 4-chamber and short axis view after anticoagulation treatment. LV: left ventricle.

Reference

1. Kalay N, Ozdogru I, Cetinkaya Y, Eryol NK, Dogan A, Gul I, Inanc T, Ikizceli I, Oguzhan A, Abaci A. Cardiovascular effects of carbon monoxide poisoning. Am J Cardiol. 2007. 99:322–324.

2. Satran D, Henry CR, Adkinson C, Nicholson CI, Bracha Y, Henry TD. Cardiovascular manifestations of moderate to severe carbon monoxide poisoning. J Am Coll Cardiol. 2005. 45:1513–1516.

3. Tucciarone M, Dileo PA, Castro ER, Guerrero M. Myocardial infarction secondary to carbon monoxide poisoning: an uncommon presentation of a common condition. Case report and review of the literature. Am J Ther. 2009. 16:462–465.

4. Jang WI, Park JH. Transient left ventricular systolic dysfunction associated with carbon monoxide toxicity. J Cardiovasc Ultrasound. 2010. 18:12–15.

5. Ernst A, Zibrak JD. Carbon monoxide poisoning. N Engl J Med. 1998. 339:1603–1608.

6. Alonso JR, Cardellach F, López S, Casademont J, Miró O. Carbon monoxide specifically inhibits cytochrome c oxidase of human mitochondrial respiratory chain. Pharmacol Toxicol. 2003. 93:142–146.

7. Cooper CE, Brown GC. The inhibition of mitochondrial cytochrome oxidase by the gases carbon monoxide, nitric oxide, hydrogen cyanide and hydrogen sulfide: chemical mechanism and physiological significance. J Bioenerg Biomembr. 2008. 40:533–539.

8. de Gregorio C, Grimaldi P, Lentini C. Left ventricular thrombus formation and cardioembolic complications in patients with Takotsubo-like syndrome: a systematic review. Int J Cardiol. 2008. 131:18–24.

9. Haghi D, Papavassiliu T, Heggemann F, Kaden JJ, Borggrefe M, Suselbeck T. Incidence and clinical significance of left ventricular thrombus in tako-tsubo cardiomyopathy assessed with echocardiography. QJM. 2008. 101:381–386.