Pathophysiology, clinics, diagnosis and treatment of heart involvement in carbon monoxide poisoning

Lippi, Giuseppe; Rastelli, Gianni; Meschi, Tiziana; Borghi, Loris; Cervellin, Gianfranco

doi:10.1016/j.clinbiochem.2012.06.004

Cited by 129 publications

(138 citation statements)

References 76 publications

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“…Cardiovascular manifestations of CO poisoning include heart rate changes, arrhythmias, contractile dysfunction, myocardial injury ranging from mild and transitory injury to necrosis, cardiogenic shock, and sudden death (2,4).…”

Section: Discussionmentioning

confidence: 99%

“…Headache is often the first symptom to appear at blood levels of approximately 10% of CO. Dizziness, dyspnea, and nausea may develop at blood levels of 20-30% of CO. Seizures, coma, cardiopulmonary dysfunction, and deaths may also appear at blood levels of 50-70% of CO (Table 1). Exposure to low levels of CO is a very rare cause of myocardial injury (1,(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

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Asymptomatic Myocardial Injury in a Low Level of Carbon Monoxide Poisoning

Hocagil¹,

Tanrıkulu²,

Ülker³

et al. 2015

JAEM

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Carbon monoxide (CO) poisoning is an important cause of mortality and morbidity. Although measured in CO levels are not always correlated with clinical symptoms, neurological symptoms may present in lower CO levels, and cardiac signs and symptoms may occur in high CO levels. Low levels of CO exposure are very rare causes of myocardial injury. In this case presentation, we aimed to report on a patient who had a 20% level of CO and high troponin level without cardiac signs and symptoms. (JAEM 2015; 14: 91-3)

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Asymptomatic Myocardial Injury in a Low Level of Carbon Monoxide Poisoning

Hocagil¹,

Tanrıkulu²,

Ülker³

et al. 2015

JAEM

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“…Hypoxia has several effects on organs and systems [1]. Troponin is the most commonly used agent for determining heart damage [6]. But no consensus has been reached on determining ischemic brain damage.…”

Section: Introductionmentioning

confidence: 99%

“…After all, it causes hypoxia in all tissues in the body [4]. According to cellular theory; CO inhibits the mitochondrial electron transport enzyme system in a cell [5,6]. Due to the high affinity of the CO on the heme, many enzymes induce the increase of the heme protein with biological signal activation [4].…”

Section: Introductionmentioning

confidence: 99%

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The use of serum hypoxia-inducible factor two alpha levels and diagnostic values in adult carbon monoxide poisoning

Altıntop¹,

Tatlı²,

Karakükçü³

et al. 2018

Med-Science

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Carbon monoxide poisoning (COP) is a life-threatening intoxication which should be interfered immediately to be prevented from serious damages. The effect of carbon monoxide (CO) in the body at the cell level is mediated by a CO-releasing molecule. This molecule results in heme degradation via heme oxygenase. Because of the high affinity of CO on heme, many enzymes with biological signal transduction cause heme protein increase. Universally, this signal activation with similar enzymes and mechanisms are used in COP. The most widely used test is Carboxyhaemoglobin (COHb) in serum. The COHb is used as a standard parameter in the diagnosis of COP. COHb levels, are high after CO poisoning and decrease rapidly with oxygen therapy in the first four hours. So COHb is insufficient to demonstrate chronic ischemic damage of hypoxia. Hypoxia-inducible factors (HIFs) are the master regulators of oxygen homeostasis. The best known HIF isoforms in the literature are HIF-1ɑ and HIF-2ɑ. Recently, more data have found about selective HIF-2ɑ responsive genes and indicate the importance of this isoform in hypoxic gene regulation. The present study purposed to determine the change in HIF-2ɑ values in adult patients in diagnosing COP. A significant statistical correlation was found between (p=0.05) serum HIF-2ɑ levels and the first COHb level. HIF-2ɑ levels at 4th hour in COP patients were significantly higher like first COHb. HIF-2ɑ levels can be used as a new biomarker in long-term for monitoring COP patients.

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A combination of NLR and sST2 is associated with adverse cardiovascular events in patients with myocardial injury induced by moderate to severe acute carbon monoxide poisoning

Liu

Gao

Xiao

et al. 2021

Clinical Cardiology

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Background Indicators of adverse cardiovascular events in patients with acute carbon monoxide (CO) poisoning‐induced myocardial injury have not yet been elucidated. Hypothesis This study aimed at determining the risk factors for adverse cardiovascular events in patients with acute CO poisoning‐induced myocardial injury. Methods We enrolled patients with moderate‐to‐severe acute CO poisoning‐induced myocardial injury. Based on the occurrence of adverse cardiovascular events, the patients were assigned into event and non‐event group. Binary logistic regression analysis was performed to analyze the potential risk factors for cardiovascular adverse events. Results A total of 413 eligible patients were enrolled. Among them, 61 (14.8%) patients presented adverse cardiovascular events and were assigned to the event group while 352 patients were assigned to the non‐event group. Univariate analysis revealed that cTnI, Lac, and NLR levels at admission and sST2 at day 3 in the event group were significantly higher compared to those in the non‐event group. Subsequent multivariate analysis revealed that sST2 at day 3 and NLR at admission were independent risk factors for adverse cardiovascular events in patients with acute CO poisoning‐induced myocardial injury. Finally, the sensitivity, specificity, and AUC of sST2 at day 3 combined with NLR for event prediction were 79.5%, 82.8%, and 0.858, respectively. Conclusion A combination of sST2 at day 3 and NLR is a potential predictor for the occurrence of adverse cardiovascular events in patients with acute CO poisoning‐induced myocardial injury. Therefore, cardiovascular risk stratification should be taken into consideration, especially in patients with acute CO poisoning‐induced myocardial injury.

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Pathophysiology, clinics, diagnosis and treatment of heart involvement in carbon monoxide poisoning

Cited by 129 publications

References 76 publications

Asymptomatic Myocardial Injury in a Low Level of Carbon Monoxide Poisoning

Asymptomatic Myocardial Injury in a Low Level of Carbon Monoxide Poisoning

The use of serum hypoxia-inducible factor two alpha levels and diagnostic values in adult carbon monoxide poisoning

A combination of NLR and sST2 is associated with adverse cardiovascular events in patients with myocardial injury induced by moderate to severe acute carbon monoxide poisoning

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