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Alarbi KMS, Baghi MA, Varikkodan I, Sirajudeen J, Al-Aani F, Purayil N, Naushad VA. Acute Cardiomyopathy and Delayed Neuropsychiatric Sequelae of Carbon Monoxide Poisoning: A Case Report. Cureus 2023; 15:e42701. [PMID: 37654911 PMCID: PMC10465715 DOI: 10.7759/cureus.42701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
Carbon monoxide (CO) is an odorless and colorless gas that is formed by the combustion of hydrocarbon. CO poisoning is not an uncommon phenomenon that can have serious consequences for morbidity and mortality. The most frequent causes of accidental poisoning include smoke inhalation from fires, malfunctioning heating devices, smoke from motor vehicles in a poorly ventilated or enclosed space, and electrical cable fires. CO has a higher affinity to hemoglobin than oxygen leading to the formation of carboxyhemoglobin. It impairs the oxygen transport and cytochrome chain which, therefore, leads to further cellular and immunological changes. Here, we present a case of CO poisoning resulting in combined cardiac and neuropsychiatric complications.
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Affiliation(s)
| | - Mohamed A Baghi
- Internal Medicine, Hamad General Hospital, Doha, QAT
- Clinical Medicine, Weill Cornell Medicine - Qatar, Doha, QAT
| | - Irfan Varikkodan
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
- Clinical Department, College of Medicine, Qatar University, Doha, QAT
| | - Jaseem Sirajudeen
- Internal Medicine, Hamad Medical corporation, Doha, QAT
- Clinical Department, College of Medicine, Qatar University, Doha, QAT
| | - Fuad Al-Aani
- Internal Medicine, Hamad General Hospital, Doha, QAT
- Clinical Medicine, Weill Cornell Medicine - Qatar, Doha, QAT
| | - Nishan Purayil
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
- Clinical Department, College of Medicine, Qatar University, Doha, QAT
- Clinical Medicine, Weill Cornell Medicine - Qatar, Doha, QAT
| | - Vamanjore A Naushad
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
- Clinical Medicine, Weill Cornell Medicine - Qatar, Doha, QAT
- Clinical Department, College of Medicine, Qatar University, Doha, QAT
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Ho YW, Chung PY, Hou SK, Chang ML, Kang YN. Should We Use Hyperbaric Oxygen for Carbon Monoxide Poisoning Management? A Network Meta-Analysis of Randomized Controlled Trials. Healthcare (Basel) 2022; 10:healthcare10071311. [PMID: 35885838 PMCID: PMC9318730 DOI: 10.3390/healthcare10071311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
Carbon monoxide (CO) poisoning is a public health issue in numerous countries. Oxygen supplementation is the standard and initial management for acute CO poisoning. Normobaric oxygen (NBO) and hyperbaric oxygen (HBO) therapies for CO poisoning have been discussed for several decades. NBO, one-session HBO, two-session HBO, and three-session HBO have not been clearly compared, although there are some syntheses. Therefore, this study aimed to provide an overview of various HBO therapies for CO poisoning. We searched online databases for randomized controlled trials (RCTs) on this topic, and two authors individually extracted data on characteristics, mortality, headache recovery, general fatigue, memory impairment, and difficulty concentrating. Outcomes were pooled using network meta-analysis. We included eight RCTs (n = 1785) that met our eligibility criteria. Pooled estimates showed that HBO had no better outcomes than NBO. Moreover, two-session HBO seemed to have a higher general fatigue rate than NBO, and compared with one-session HBO therapy, it had a higher fatigue rate (risk ratio (RR): 1.29, 95% confidence interval (CI): 1.03–1.62), memory impairment rate (RR = 1.80, 95% CI: 1.01–3.19), and concentration impairment rate (RR = 1.85, 95% CI: 1.19–2.89). HBO may be ineffective for patients with CO poisoning. Therefore, clinicians should consider the available treatment options carefully before recommending HBO to patients.
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Affiliation(s)
- Yu-Wan Ho
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan; (Y.-W.H.); (P.-Y.C.); (S.-K.H.)
| | - Ping-Yen Chung
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan; (Y.-W.H.); (P.-Y.C.); (S.-K.H.)
| | - Sen-Kuang Hou
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan; (Y.-W.H.); (P.-Y.C.); (S.-K.H.)
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Ming-Long Chang
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan; (Y.-W.H.); (P.-Y.C.); (S.-K.H.)
- Correspondence: (M.-L.C.); (Y.-N.K.); Tel.: +886-2-27372181 (M.-L.C.)
| | - Yi-No Kang
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan; (Y.-W.H.); (P.-Y.C.); (S.-K.H.)
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: (M.-L.C.); (Y.-N.K.); Tel.: +886-2-27372181 (M.-L.C.)
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Martani L, Giovanniello A, Bosco G, Cantadori L, Calissi F, Furfaro D, Pedrazzini M, Vaschetto R, Camporesi EM, Paganini M. Delayed Neurological Sequelae Successfully Treated with Adjuvant, Prolonged Hyperbaric Oxygen Therapy: Review and Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095300. [PMID: 35564694 PMCID: PMC9104642 DOI: 10.3390/ijerph19095300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022]
Abstract
Carbon Monoxide (CO) intoxication is still a leading cause of mortality and morbidity in many countries. Due to the problematic detection in the environment and subtle symptoms, CO intoxication usually goes unrecognized, and both normobaric and hyperbaric oxygen (HBO) treatments are frequently administered with delay. Current knowledge is mainly focused on acute intoxication, while Delayed Neurological Sequelae (DNS) are neglected, especially their treatment. This work details the cases of two patients presenting a few weeks after CO intoxication with severe neurological impairment and a characteristic diffused demyelination at the brain magnetic resonance imaging, posing the diagnosis of DNS. After prolonged treatment with hyperbaric oxygen, combined with intravenous corticosteroids and rehabilitation, the clinical and radiological features of DNS disappeared, and the patients' neurological status returned to normal. Such rare cases should reinforce a thorough clinical follow-up for CO intoxication victims and promote high-quality studies.
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Affiliation(s)
- Luca Martani
- Vaio Hospital, 43036 Fidenza, Italy; (L.M.); (L.C.); (M.P.)
| | | | - Gerardo Bosco
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy;
- Correspondence:
| | - Luca Cantadori
- Vaio Hospital, 43036 Fidenza, Italy; (L.M.); (L.C.); (M.P.)
| | | | | | | | - Rosanna Vaschetto
- Department of Translational Sciences, University of Eastern Piedmont, 28100 Novara, Italy;
| | | | - Matteo Paganini
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy;
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Application of Mitochondrial and Oxidative Stress Biomarkers in the Evaluation of Neurocognitive Prognosis Following Acute Carbon Monoxide Poisoning. Metabolites 2022; 12:metabo12030201. [PMID: 35323645 PMCID: PMC8952273 DOI: 10.3390/metabo12030201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/10/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022] Open
Abstract
Mitochondrial and oxidative stress play critical roles in the pathogenic mechanisms of carbon monoxide (CO)-induced toxicity. This study was designed to evaluate whether the serum levels of specific stress biomarkers might reflect brain injury and act as prognostic markers for the development of neurocognitive sequelae following CO poisoning. We analyzed the data from 51 adult patients admitted with acute CO poisoning and measured the serum level expression of growth differentiation factor 15 (GDF15) and fibroblast growth factor 21 (FGF21), indicators of mitochondrial stress, and 8-Oxo-2′-deoxyguanosine (8-OHdG) and malondialdehyde (MDA), indicators of oxidative stress. Serum was collected upon arrival at the hospital, at 24 h post treatment, and within 7 days of HBO2 therapy. Global Deterioration Scale scores were measured 1 month post incident and used to place the patients in either favorable or poor outcome groups. Initial serum GDF15 and 8-OHdG concentrations were significantly increased in the poor-outcome group and all four biomarkers decreased at 24 h post HBO2 therapy, and were then maintained or further decreased at the 1-week mark. Notably, the degree of change in these biomarkers between baseline and 24 h post HBO2 were significantly larger in the poor-outcome group, reflecting greater CO-associated stress, confirming that post-CO poisoning serum biomarker levels and their response to HBO2 were proportional to the initial stress. We suggest that these biomarkers accurately reflect neuronal toxicity in response to CO poisoning, which is consistent with their activity in other pathologies.
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Rezaee MA, Moallem SA, Mohammadpour AH, Mahmoudi M, Sankian M, Farzadnia M, Alavi H, Imenshahidi M. Histopathological study of erythropoietin protective effect on carbon monoxide-induced cardiotoxicity in rat. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2018; 20:1189-1193. [PMID: 29299194 PMCID: PMC5749351 DOI: 10.22038/ijbms.2017.9471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective(s): Cardiotoxicity is one of the major consequences in carbon monoxide poisoning. Following our previous work, in this study we aimed to define the myocardium changes induced by carbon monoxide (CO) intoxication and evaluate erythropoietin (EPO) effect on CO cardiotoxicity in rat. Materials and Methods: Severe carbon monoxide toxicity induced by 3000 ppm CO in Wistar rat. EPO was administrated (5000 IU/Kg, intraperitoneal injection) at the end of CO exposure and then the animals were re-oxygenated with the ambient air. Subsequently heart was removed and assessed by histopathology and electron microscopy examinations. Results: 3000 ppm CO induced significant myocardium injury; multiple foci of necrosis and lymphocyte infiltration compare with the control (P<0.05). Electron microscopy examination showed myofibril lysis and mitochondrial swelling in myocardium due to 3000 ppm CO poisoning. However EPO administration after CO exposure resulted in significant reduction in cardiomyocytes injury (P<0.05). Conclusion: Our results represented protective effect of EPO on cardiac injury induced by CO intoxication in rat.
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Affiliation(s)
- Mitra Asgharian Rezaee
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Toxicology and Pharmacology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran.,Pharmaceutical Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Seyed Adel Moallem
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.,Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Hooshang Mohammadpour
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.,Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Mahmoudi
- Immunology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Sankian
- Immunobiochemistry Laboratory, Immunology Research Center, Bu-Ali research Institute, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Farzadnia
- Department of Pathology, School of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hassan Alavi
- Electron Microscope Unit, Bu-Ali Research Institute, Mashhad University of Medical Science, Mashhad, Iran.,School of Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Mohsen Imenshahidi
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Kaya H, Coşkun A, Beton O, Zorlu A, Kurt R, Yucel H, Gunes H, Yılmaz MB. COHgb levels predict the long-term development of acute myocardial infarction in CO poisoning. Am J Emerg Med 2016; 34:840-4. [PMID: 26947364 DOI: 10.1016/j.ajem.2016.01.036] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There are several studies evaluating the cardiac effects of carbon monoxide (CO) poisoning during the acute period; however, the number of studies evaluating the long-term cardiac effects is limited. OBJECTIVE The present study aimed to evaluate the effects of blood carboxyhemoglobin (COHb) levels, elevated due to CO poisoning on the long-term development of acute myocardial infarction (AMI). METHODS This cross-sectional cohort study included a total of 1013 consecutive patients who presented to the emergency department (ED) due to CO poisoning, between January 2005 and December 2007. The diagnosis of CO poisoning was made according to the medical history and a COHb level of greater than 5%. In terms of AMI development, the patients were followed up for an average of 56 months. RESULTS At the end of follow-up, 100 (10%) of 1013 patients experienced AMI. Carboxyhemoglobin levels at the time of poisoning were higher among those who were diagnosed with AMI compared to those who were not (55%±6% vs 30%±7%; P<.001). Using a multivariate Cox proportional hazards model with forward stepwise method, age, COHb level, CO exposure time, and smoking remained associated with an increased risk of AMI after adjustment for the variables found to be statistically significant in a univariate analysis. According to a receiver operating characteristic curve analysis, the optimal cutoff value of COHb used to predict the development of AMI was found to be greater than 45%, with 98% sensitivity and 94.1% specificity. CONCLUSION In patients presenting to the ED with CO poisoning, COHb levels can be helpful for risk stratification in the long-term development of AMI.
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Affiliation(s)
- Hakki Kaya
- Department of Cardiology, Cumhuriyet University Medical School, Sivas, Turkey.
| | - Abuzer Coşkun
- Department of Emergency, Sivas State Hospital, Sivas, Turkey
| | - Osman Beton
- Department of Cardiology, Cumhuriyet University Medical School, Sivas, Turkey
| | - Ali Zorlu
- Department of Cardiology, Cumhuriyet University Medical School, Sivas, Turkey
| | - Recep Kurt
- Department of Cardiology, Sivas State Hospital, Sivas, Turkey
| | - Hasan Yucel
- Department of Cardiology, Cumhuriyet University Medical School, Sivas, Turkey
| | - Hakan Gunes
- Department of Cardiology, Sivas State Hospital, Sivas, Turkey
| | - M Birhan Yılmaz
- Department of Cardiology, Cumhuriyet University Medical School, Sivas, Turkey
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7
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McEwen BJ. Nondrowning Asphyxia in Veterinary Forensic Pathology: Suffocation, Strangulation, and Mechanical Asphyxia. Vet Pathol 2016; 53:1037-48. [PMID: 27084399 DOI: 10.1177/0300985816643370] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Asphyxia in a forensic context refers to death by rapid cerebral anoxia or hypoxia due to accidental or nonaccidental injury. Death due to nondrowning asphyxia can occur with strangulation, suffocation, and mechanical asphyxia, each of which is categorized based on the mechanism of injury. Individuals dying due to various types of asphyxia may or may not have lesions, and even those lesions that are present may be due to other causes. The interpretation or opinion that death was due to asphyxia requires definitive and compelling evidence from the postmortem examination, death scene, and/or history. Beyond the postmortem examination, pathologists may be faced with questions of forensic importance that revolve around the behavioral and physiological responses in animals subjected to strangulation, suffocation, or mechanical asphyxia to determine if the animal suffered. While there is no prescriptive answer to these questions, it is apparent that, because of physiological and anatomical differences between humans and animals, for some mechanisms of asphyxia, consciousness is maintained for longer periods and the onset of death is later in animals than that described for people. Veterinary pathologists must be cognizant that direct extrapolation from the medical forensic literature to animals may be incorrect. This article reviews the terminology, classification, mechanisms, and lesions associated with asphyxial deaths in companion animals and highlights significant comparative differences of the response to various types of asphyxia in animals and people.
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Affiliation(s)
- B J McEwen
- Animal Health Laboratory, University of Guelph, Guelph, Ontario, Canada
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9
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Jung YS, Lee JS, Min YG, Park JS, Jeon WC, Park EJ, Shin JH, Oh S, Choi SC. Carbon monoxide-induced cardiomyopathy. Circ J 2014; 78:1437-44. [PMID: 24705389 DOI: 10.1253/circj.cj-13-1282] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Previous reports demonstrated mechanisms of cardiac toxicity in acute carbon monoxide (CO) poisoning. Still, none established CO-induced cardiomyopathy (CMP) as a clinical entity. The aim of this study is to investigate CO-induced CMP in patients with acute CO poisoning in terms of its epidemiology, clinical characteristics, and prognosis. METHODS AND RESULTS A retrospective study was conducted on consecutive patients who were diagnosed with acute CO poisoning at the emergency department of Ajou University Hospital during the period of 62 month. Six hundred and twenty-six patients were diagnosed with acute CO poisoning. During the initial echocardiography, 19 patients were abnormal: (1) global hypokinesia/akinesia (n=7), (2) regional wall hypokinesia/akinesia [n=12; takotsubo type (n=6), reverse takotsubo type (n=2), non-specific type (n=4)]. The ejection fraction (EF) was 36.3±13.5% (from 15% to 55%) and less than 45% for 14 patients. In the follow-up echocardiography performed within 12 days after the initial performance, most patients were found to have cardiac wall motion abnormalities, and their EF had returned to normal (ie, EF ≥50%). CONCLUSIONS CO-induced CMP was identified in 3.04% (n=19) of all patients (n=626). It might not be too critical in acute clinical courses of acute CO poisoning because the prognosis seems favorable. Considering the common factors between CO-induced CMP and takotsubo CMP, myocardial stunning subject to a catecholamine surge most likely plays a central role in the development of CO-induced CMP.
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Affiliation(s)
- Yoon-Seok Jung
- Department of Emergency Medicine, Ajou University School of Medicine
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10
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An Autopsy Case of Acute Carbon Monoxide Poisoning After a Long-Term Vegetative State. Am J Forensic Med Pathol 2012; 33:341-3. [DOI: 10.1097/paf.0b013e318273b823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Immunohistochemical expression of fibronectin and C5b-9 in the myocardium in cases of carbon monoxide poisoning. Int J Legal Med 2010; 125:377-84. [DOI: 10.1007/s00414-010-0512-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 08/26/2010] [Indexed: 10/19/2022]
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Abstract
Carbon monoxide (CO), a highly toxic gas produced by incomplete combustion of hydrocarbons, is a relatively common cause of human injury. Human toxicity is often overlooked because CO is tasteless and odorless and its clinical symptoms and signs are non specific. The brain and the heart may be severely affected after CO exposure with carboxyhemoglobin (COHb) levels exceeding 20%. Damage occurs because the affinity of hemoglobin for CO is 210 times higher than for O(2). Hypoxic brain damage predominates in the cerebral cortex, cerebral white matter and basal ganglia, especially in the globus pallidus. Diagnosis requires clinical acumen and a high index of suspicion, combined with epidemiological data, clinical examination, analysis of ambient air CO and patient COHb levels; also required are cardiology evaluation including ECG as well as neurological evaluation including brain imaging (CT and/or MRI, MR spectroscopy), and neuropsychological testing. Although immediate O(2) breathing is sometimes an adequate treatment, hyperbaric oxygen therapy (HBO) is favored. Subsequently, only symptomatic therapy is available for the long-term sequelae of CO poisoning.
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Affiliation(s)
- Leon D Prockop
- Department of Neurology, College of Medicine, University of South Florida, FL, USA.
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13
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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; 99:322-4. [PMID: 17261390 DOI: 10.1016/j.amjcard.2006.08.030] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 08/10/2006] [Accepted: 08/10/2006] [Indexed: 11/23/2022]
Abstract
Carbon monoxide (CO) poisoning is an important health problem. Cardiac abnormalities may occur in patients with CO poisoning; however, the severity and duration of cardiac abnormalities are not well known. In this study, cardiac structures and function in CO poisoning were evaluated prospectively. Twenty patients were enrolled in the study. Echocardiographic examination was performed in all patients on admission, at 24 hours, and within the first week. B-type natriuretic peptide and carboxyhemoglobin levels were measured. Patients with increased cardiac markers underwent coronary angiography. Cardiac markers were high in 6 patients. Patients with high cardiac markers had significantly higher carboxyhemoglobin levels and longer exposure to CO. Left ventricular ejection fraction (LVEF) was <45% in 8 patients (group I) on admission and >55% in 7 patients in group I 24 hours after echocardiography. A significant negative correlation was found between B-type natriuretic peptide and LVEF on admission (r = -0.586, p <0.01). The decrease in LVEF was also negatively correlated with carboxyhemoglobin level and CO exposure duration. All angiograms showed normal coronary arteries. In conclusion, despite normal coronary arteries, myocardial dysfunction may occur in patients with CO poisoning. LV systolic function might be normal or mildly to severely impaired. However, most of the myocardial dysfunction dissipates at 24 hours in patients with CO poisoning.
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Affiliation(s)
- Nihat Kalay
- Department of Cardiology, Erciyes University, School of Medicine, Kayseri, Turkey.
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Wattel F, Favory R, Lancel S, Neviere R, Mathieu D. Monoxyde de carbone et coeur : des effets univoques ? BULLETIN DE L ACADEMIE NATIONALE DE MEDECINE 2006. [DOI: 10.1016/s0001-4079(19)33139-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mizrak B, Celbiş O, Parlakpinar H, Olmez E. Effect of melatonin and atenolol on carbon monoxide cardiotoxicity: an experimental study in rats. Basic Clin Pharmacol Toxicol 2006; 98:565-8. [PMID: 16700818 DOI: 10.1111/j.1742-7843.2006.pto_266.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this study was to define the characteristics of heart rates and myocardial changes in rats exposed to carbon monoxide (CO), and the effects of reoxygenation, atenolol (a beta-blocker) and melatonin after sublethal CO intoxication. Widespread use of beta-blockers in cardiology practice and growing literature on the positive effect of melatonin in ischaemia reperfusion lead us to question their effects in case of CO intoxication. Rats were exposed to CO. After sublethal intoxication the rats were reoxygenated with ambient air. Subsequently blood values, electrocardiographic recordings and pathological changes were examined for each groups. Five rats died after CO intoxication in the control group: no myocardial changes were seen in light microscopy. However, myocardium of seven reoxygenated rats presented contraction bands. Seven reoxygenated rats pretreated with atenolol had a higher number of contraction bands of myocardial cells. Seven reoxygenated rats pretreated with melatonin had more contraction bands than reoxygenated rats, and heart rate recordings of these animals revealed a profund and sustained bradycardia. Thus, melatonin and atenolol appear to have some adverse effects in CO intoxication on the myocardial cells.
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Affiliation(s)
- Bülent Mizrak
- Department of Pathology, Inönü University Medical School, Malatya, Turkey.
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16
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Turillazzi E, Baroldi G, Silver MD, Parolini M, Pomara C, Fineschi V. A systematic study of a myocardial lesion: Colliquative myocytolysis. Int J Cardiol 2005; 104:152-7. [PMID: 16168807 DOI: 10.1016/j.ijcard.2004.10.051] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2004] [Revised: 10/03/2004] [Accepted: 10/04/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND The term "myocytolysis" was first used to define the repair process of contraction band necrosis associated with an acute myocardial infarction. On the other hand, in the latter condition a "myofibrillolysis," presenting edematous myocardial cells not involved by infarct necrosis, and without evidence of repair process was reported. The objective of this study is to establish the frequency, extent and meaning of this myocardial lesion. MATERIALS AND METHODS In 12 groups of patients for a total of 432 cases with and without coronary heart disease, "colliquative myocytolysis"--i.e., progressive vacuolization by loss of myofibrils until their total or subtotal disappearance associated with intramyocellular edema in absence of any cellular reaction--was graded in 16 histological slides of the different cardiac regions in each pathological case. RESULTS Colliquative myocytolysis (CM) was present in more than 90% with a maximal extent in cases of irreversible congestive heart failure followed by transplanted heart cases (67%) with a survival greater than 1 week. In all other groups, the lesion was absent or minimal. CONCLUSIONS No correlation was found between CM and contraction band necrosis, gender, age, heart weight, myocardial fibrosis, coronary artery stenosis, clinical data. Colliquative myocytolysis is a specific histological marker of congestive heart failure, without relation to coronary blood flow, heart weight and myocardial fibrosis. Vacuolization of myocardial cells may be due to other causes (e.g., storage disease, etc.) or may be an artifact. There is no support for the belief that coronary ischemia or myocardial hypoxia is its causes.
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Affiliation(s)
- E Turillazzi
- Department of Forensic Pathology, University of Foggia, Ospedali Riuniti, Via L. Pinto no. 1, 71100 Foggia, Italy.
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Fineschi V, Karch SB, D'Errico S, Pomara C, Riezzo I, Turillazzi E. Cardiac pathology in death from electrocution. Int J Legal Med 2005; 120:79-82. [PMID: 16078070 DOI: 10.1007/s00414-005-0011-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Accepted: 06/10/2005] [Indexed: 10/25/2022]
Abstract
To better characterize the morphologic changes in electrocution, morphologic changes in the hearts of 21 subjects, who died instantaneously of electrocution, were compared to the hearts of decedents with different types of death. Sixteen myocardial samples per heart were processed for histological examination, and sections were prepared with a variety of specific stains. The frequency, location and extent of myocellular segmentation (stretching and/or rupture) of intercalated discs and associated changes of myocardial bundles and single myocells [myofibre break-up (MFB)] were recorded, quantitatively analysed and statistically evaluated. The frequency of MFB was maximal in cases of electrocution (90%). The findings show that MFB is an ante-mortem change and may be a distinct finding in electrocution.
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Affiliation(s)
- Vittorio Fineschi
- Institute of Forensic Pathology, Faculty of Medicine, University of Foggia, Ospedali Riuniti, Via L. Pinto 1, 71100 Foggia, Italy.
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Baroldi G, Silver MD, Parolini M, Pomara C, Turillazzi E, Fineschi V. Myofiberbreak-up: A marker of ventricular fibrillation in sudden cardiac death. Int J Cardiol 2005; 100:435-41. [PMID: 15837088 DOI: 10.1016/j.ijcard.2004.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2004] [Revised: 08/08/2004] [Accepted: 10/04/2004] [Indexed: 11/20/2022]
Abstract
BACKGROUND Electrophysiologically, ventricular fibrillation is defined as a "chaotic, random, asynchronous electrical activity of the ventricles due to repetitive re-entrant excitation and/or rapid focal discharge". To this point its morphological equivalent has not been defined. MATERIAL AND METHOD Several groups of different diseases and types of accidental death in normal subjects were studied. A complete autopsy was performed and the hearts were examined in 432 cases. A total of 16 myocardial samples per heart were processed for histological examination and sections were stained by haematoxylin and eosin or by specific stains. The frequency, location and extent of myocellular segmentation (stretching and/or rupture) of intercalated discs and associated changes of myocardial bundles and single myocells were investigated. A quantitative analysis was performed and the data were processed for statistical evaluation. RESULTS The frequency of MFB was maximal in coronary (88%) and Chagas (76%) groups followed by the intracranial brain haemorrhage group (52%). The extent of myofiberbreak-up was maximal in coronary/Chagas groups followed by intracranial haemorrhage and transplant groups. CONCLUSIONS No correlation was seen between gender, age, heart weight, degree of coronary atherosclerosis, myocardial fibrosis, survival and MFB. If our postulate is correct, finding MFB in the myocardium might allow the diagnosis of a malignant arrhythmia followed by cardiac arrest due to ventricular fibrillation even in the absence of clinical information (sudden death out-of-hospital).
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Affiliation(s)
- Giorgio Baroldi
- Institute of Clinical Physiology, National Research Council (CNR), Pisa and Milan, Italy
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Bajanowski T, Ortmann C, Teige K, Wedekind H, Zack F, Röse I, Brinkmann B. Pathological changes of the heart in sudden infant death. Int J Legal Med 2003; 117:193-203. [PMID: 12827378 DOI: 10.1007/s00414-003-0374-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2002] [Accepted: 01/08/2003] [Indexed: 01/20/2023]
Abstract
There are more than 120 different theories on the possible causes of sudden infant death (SID). In particular, dysfunctions of the central nervous system, cardiorespiratory insufficiency due to infections including atypical immune reactions, and cardiac dysregulation have been discussed during the previous decade. Reports on disturbances of the cardiac rhythmogenic function due to LQTS were among the most speculative. Based on gross histological, immunohistochemical and molecular genetic investigations of SID cases, the most important and most frequent findings of the heart are shown. The significance of different types of myocarditis, hypoxia-related changes, disturbances of the rhythmogenic function, cardiomyopathy, and other changes is discussed with regard to the cause of death. In conclusion, most of the changes reported in the literature are not sufficient to explain the cause of death. Problems in the diagnosis are shown which influence the classification of these disturbances as well as the classification of SID.
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Affiliation(s)
- T Bajanowski
- Institute of Legal Medicine, University Münster, Röntgenstrasse 23, 48149, Münster, Germany
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Fineschi V, Centini F, Monciotti F, Turillazzi E. The cocaine "body stuffer" syndrome: a fatal case. Forensic Sci Int 2002; 126:7-10. [PMID: 11955824 DOI: 10.1016/s0379-0738(02)00011-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Body stuffer, sometimes called "mini packer", is the definition of someone who admits to or is strongly suspected of ingesting illegal drugs in order to escape detection by authorities, and not for recreational purposes or to transport the drug across borders. Cocaine is the drug most commonly involved in the body stuffer syndrome. Reported cases of body stuffer deaths are rare, however a fatality related to the ingestion of a plastic bag containing cocaine is described regarding a 17-year-old dealer. The authors describe how the cocaine body stuffer syndrome differs from the usual body packer. Histological and toxicological findings are examined and discussed for a better definition of this unique syndrome.
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Affiliation(s)
- Vittorio Fineschi
- Institute of Legal Medicine, University of Foggia, Ospedali Riuniti, Via L. Pinto 1, I-71100, Foggia, Italy.
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Abstract
We investigated retrospectively the forensic autopsy cases of suicide by self-immolation in Berlin from 1990 to 2000. There were 46 cases (35 men and 11 women), corresponding to 0.76% of all known suicides committed in Berlin during this period. The most common reasons for self-immolation were separation from a partner or financial problems. Two individuals had political reasons. There was a history of mental disturbances in 65% of these suicide cases. The location of the self-immolation was outdoors in 65%, the rest were indoors, except for three victims, who committed suicide in their cars. In nearly all cases, the individuals had doused themselves with an inflammable fluid, usually petrol. One-third of the victims died from burn shock, about 20% from a combination of severe burns and inhalation trauma. The median body surface area burnt was 78% for all cases. The blood had a mean 21% carboxyhemoglobin concentration and 0.07 microg/ml of cyanide. Suicide by self-immolation was committed under the influence of drugs in nine cases and of alcohol in 11 cases.
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Affiliation(s)
- M A Rothschild
- Institute of Legal Medicine, Freie Universität Berlin, Hittorfstrasse 18, 14195 Berlin, Germany.
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