Acute myocardial injury following hydrogen sulfide poisoning

Abstract

Background: Hydrogen sulfide poisoning can cause severe myocardial injury, but the damage is subtle and can be easily misdiagnosed. This report presents the dynamic observation of myocardial injury associated with hydrogen sulfide poisoning. Case report: Two young men presented with symptoms of “lightning-like” death immediately after entering a tank. They were found and rescued in 20 min at a time when they were already in a coma. Case 1 had no spontaneous breathing and pulse, while case 2 had spontaneous breathing and a pulse. Upon transfer to a local hospital, case 1 received continuous cardiopulmonary resuscitation which led to the recovery of his heart rate 3 min after arriving at the hospital. However, the patient remained in a Glasgow coma scale of 3. He was transferred to our hospital where he, unfortunately, died on the seventh day due to multiple organ failure. Case 2 was also transferred to the intensive care unit in our hospital and on the fourth day of hospitalization, the patient presented ST-segment elevation and dynamic changes in markers of myocardial injury. Changes in electrocardiogram and markers of myocardial injury were monitored and examination improved through conventional echocardiography, coronary artery CT, radionuclide myocardial perfusion imaging, and two-dimensional speckle tracking imaging strain. The treatment gradually improved the patient’s myocardial injury and was discharged from the hospital. Conclusion: Hydrogen sulfide poisoning can cause damage to myocardial function and the damage can be more insidious in nature and with a delayed onset. Recovery from myocardial damage can be very slow.

Air Pollution and Cardiac Arrhythmias: From Epidemiological and Clinical Evidences to Cellular Electrophysiological Mechanisms

“…The ST-segment elevation was also reported in another clinical study (135). The patient was exposed to 20.3∼25.6 mg/m 3 (20.3∼25.6 ppb) H 2 S but showed no obvious ECG changes on the first day of admission; however, subsequent significant ST-segment elevation along with changes in markers of myocardial injury was observed on the fourth day of hospitalization (135). Another recent case presented identical cardiac changes and clinical course, where the patient was free of ECG abnormalities on the first day of exposure, but showed extensive elevation of ST-segment and dramatic increase of myocardial enzyme index two days after exposure.…”

“…The patient died on the third day in the hospital (134). The ST-segment elevation was also reported in another clinical study (135). The patient was exposed to 20.3∼25.6 mg/m 3 (20.3∼25.6 ppb) H 2 S but showed no obvious ECG changes on the first day of admission; however, subsequent significant ST-segment elevation along with changes in markers of myocardial injury was observed on the fourth day of hospitalization (135).…”

“…The clinically observed ST-segment changes on the ECG suggest the occurrence of myocardial injury when exposed to H 2 S. Similar to CO, H 2 S causes myocardial damages due to its mitochondria toxicity. Specifically, H 2 S was reported to inhibit cytochrome C oxidase (137), leading to the blockade of the electron transport in the respiratory chain and the utilization of molecular oxygen (135,138). The damaged respiratory chain could subsequently result in disrupted aerobic metabolism of cells and impaired ATP production, and ultimately leads to reduced oxygen use of cardiomyocytes and myocardial damage (136).…”

Cardiogenic shock following hydrogen sulfide poisoning

“…Delayed myocardial damage can occur in a few days after exposure, and clinical manifestations include STsegment elevation, increased myocardial markers, decreased ventricular wall motion, myocardial infarction , arrhythmia, etc. 5 It can develop within a few weeks and most of them died of circulatory failure caused by acute inhibition of myocardial contractility. We successfully helped the patient go through this acute stage with the support by combination of IABP and VA-ECMO.…”

A case of syncope in a villager with hypertrophic cardiomyopathy after hydrogen sulfide exposure by an unauthorized discharge of wastewater

“… 3 4 After recovery from acute poisoning from hydrogen sulfide, peripheral neuropathy, and delirium can still occur, and there have been reports of bradycardia, cardiac hypertrophy, myocardial injury, and proteinuria. 5 6 7 …”