Functional and ultrastructural evidence of myocardial stunning after acute carbon monoxide poisoning

Luigi Tritapepe, Guido Macchiarelli, Monica Rocco, Francesco Scopinaro, Orazio Schillaci, Eugenio Martuscelli, Pietro M. Motta

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To study human myocardial ultrastructural changes after carbon monoxide (CO) poisoning inducing reversible cardiac failure. Design: Case report: clinical, functional and morphologic findings. Settings: Public university-affiliated hospital and electron microscopy laboratory. Patient: A 25-yr-old woman with functional evidence of cardiac failure after acute CO poisoning. Interventions: Hyperbaric and intensive care treatment over 10 days. Scintigraphic and cardiac angiography with endomyocardial biopsy. Measurements and Main Results: Scintigraphy with (99m)Tc hexakis 2-methoxy- 2-isobutyl isonitrile (sestaMIBI) showed an uptake defect in the left anterior descending artery territory. The cardiac angiography demonstrated a slight hypokinesis of the superior two thirds of the anterior wall and of the septal region with completely normal coronary angiograms. Electron microscopy of left ventricular biopsies showed slight ultrastructural changes in the myocytes. In addition, large glycogen deposits were mostly associated with swollen mitochondria. The patient was discharged in good clinical condition on day 10. Conclusions: Presence of glycogen deposits associated with abnormal mitochondria may be signs of the incapability of myocardial cells in utilizing energy substrata. In the presence of normal myocardial perfusion, our findings are consistent with the presence of a stunned myocardium-like syndrome. Early recognition and treatment of this clinical syndrome allow the prevention of myocardial infarction.

Original languageEnglish
Pages (from-to)797-801
Number of pages5
JournalCritical Care Medicine
Volume26
Issue number4
DOIs
Publication statusPublished - 1998

Keywords

  • Carbon monoxide poisoning
  • Endomyocardial biopsy
  • Heart failure
  • Human
  • Myocardial stunning
  • Myocardium
  • Technetium-(99m) MIBI
  • Transmission electron microscopy
  • Ultrastructure

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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