Letters to the Editors: ST-elevation myocardial infarction after acute carbon monoxide poisoning

Dear Editor, Myocardial infarction (MI) is rarely reported in course of acute car- bon monoxide poisoning (COP) (1). Pathogenesis of cardiac toxicity caused by carbon monoxide (CO) is rather complex. A 38-years-old male patient referred to our emergency department with altered consciousness, dyspnea and chest discomfort five hours after acute exposure to CO in a burning apartment. His arterial blood pressure was 145/95 mmHg, pulse rate was 142 beats/min with a regular rhythm. A 2/6 systolic murmur was audible along left sternal border. Electrocardiogram taken at admission showed ST segment elevation in precordial derivations (Fig. 1). After immediate oxygen supplementation with a flow rate of 6 L/min, arterial blood was obtained for analysis. In blood gas analysis, pH was 7.34; oxygen saturation was 86%, partial oxygen pressure was 75 mmHg, partial CO2 pressure was 42 mmHg, bicarbonate concentration was 16 mmol/L, and carboxyhemoglobin (COHb) saturation was 14%. 300 mg acetylsalicylate and 600 mg clopidogrel were administered to patient immediate before emergency angiography. Coronary angiography revealed total occlusion of proximal left anterior descending artery.