Cardiac and Thrombotic Effects of Severe Carbon Monoxide Poisoning: A Case Series.

Introduction: Carbon monoxide (CO) poisoning is the most common source of poisoning in the United States. Acute poisoning can cause a wide range of symptoms. CO poisoning can have long-term morbidity as well, the most well-described of which is the development of delayed neurologic sequelae. CO can cause acute and chronic cardiovascular and thrombotic effects as well. Case Report: We describe four cases of severe CO poisoning with distinct cardiac and thrombotic effects. Carboxyhemoglobin levels ranged from 23.1%-42.5%. All four were critically ill and intubated. All four were evaluated with transthoracic echocardiography (TTE), electrocardiogram, and laboratory evaluation. Three of the four patients developed decreased ejection fraction, and two had new wall-motion abnormalities noted on TTE. One underwent cardiac catheterization. Two of the patients developed thrombi. All four cases were quickly and aggressively treated with a course of hyperbaric oxygen. Discussion: Carbon monoxide (CO) can cause significant cardiac and thrombotic effects. All four patients had troponin elevations and changes noted on TTE. Two patients developed thrombi. These changes were resolved in the two patients who were seen in post-hospital follow-up. Physicians should remain vigilant when managing these patients in the Emergency Department.