Cardiac damage in pediatric carbon monoxide poisoning.
BACKGROUND
Cardiovascular disorders including myocardial ischemia and heart failure have been described in both laboratory animals and humans following carbon monoxide poisoning. Carbon monoxide cardiotoxicity may be clinically occult and often remains undiagnosed because of the lack of overt symptoms and specific ischemic changes in the electrocardiogram. Routine myocardial necrosis markers have low diagnostic efficiency, particularly in patients with concomitant skeletal muscle necrosis or multiple organ failure complicating carbon monoxide poisoning. Carbon monoxide-induced cardiotoxicity has been investigated rarely in children.


METHODS
This paper describes carbon monoxide poisoning in a 12-year-old child who suffered from occult cardiac damage despite mild symptoms and low carboxy hemoglobin concentrations. Myocardial and mitral valve dysfunctions were observed, suggesting an ischemia-like syndrome. Cardiac damage was completely reversible within 1 month.


CONCLUSIONS
This case report supports that a prolonged carbon monoxide exposure can cause cardiac damage in children even in the absence of specific symptoms, cerebral failure and high carboxyhemoglobin concentrations.
Gandini
C
C
Toxicology, Molecular Cardiology and Electrophysiology Units, IRCCS Salvatore Maugeri Foundation, Institute of Pavia, Italy. cnit@fsm.it
Castoldi
A F
AF
Candura
S M
SM
Priori
S
S
Locatelli
C
C
Butera
R
R
Bellet
C
C
Manzo
L
L
D002249:Carbon Monoxide Poisoning / Q000503:physiopathology* / Q000628:therapy; D002263:Carboxyhemoglobin / Q000302:isolation & purification; D002648:Child; D004562:Electrocardiography; D006349:Heart Valve Diseases / Q000139:chemically induced*; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000139:chemically induced*; D010100:Oxygen / Q000008:administration & dosage*; D010372:Pediatrics
D002263:Carboxyhemoglobin; D010100:Oxygen