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

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ObjectiveTo study human myocardial ultrastructural changes after carbon monoxide (CO) poisoning inducing reversible cardiac failure.DesignCase report: clinical, functional and morphologic findings.SettingsPublic university-affiliated hospital and electron microscopy laboratory.PatientA 25-yr-old woman with functional evidence of cardiac failure after acute CO poisoning.InterventionsHyperbaric and intensive care treatment over 10 days. Scintigraphic and cardiac angiography with endomyocardial biopsy.Measurements and Main ResultsScintigraphy with99m 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.ConclusionsPresence 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. (Crit Care Med 1998; 26:797-801)

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