Intracoronary Thrombus Formation Following Carbon Monoxide Poisoning†
Marilou Caron-Cantin B.Sc.
Faculty of Medicine, McGill University, 3605 Mountain St, Montreal, QC, H3G 2M1 Canada
Search for more papers by this authorMarcia Abbott M.D.
Department of Pathology and Laboratory Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4 Canada
Search for more papers by this authorElizabeth Brooks-Lim M.D.
Department of Pathology and Laboratory Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4 Canada
Department of Laboratory Medicine and Pathology, University of Alberta, 116 St. and 85 Ave, Edmonton, AB, T6G2R3 Canada
Office of the Chief Medical Examiner, 4070 Bowness Rd NW, Calgary, AB, T3B 3R7 Canada
Search for more papers by this authorCorresponding Author
Bamidele Adeagbo M.D.
Department of Pathology and Laboratory Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4 Canada
Department of Laboratory Medicine and Pathology, University of Alberta, 116 St. and 85 Ave, Edmonton, AB, T6G2R3 Canada
Office of the Chief Medical Examiner, 4070 Bowness Rd NW, Calgary, AB, T3B 3R7 Canada
Additional information and reprint requests:
Bamidele Adeagbo, M.D.
Forensic Pathologist, Assistant Chief Medical Examiner
Office of the Chief Medical Examiner
4070 Bowness Rd NW
Calgary, Alberta, T3B 3R7
Canada
E-mail: [email protected]
Search for more papers by this authorMarilou Caron-Cantin B.Sc.
Faculty of Medicine, McGill University, 3605 Mountain St, Montreal, QC, H3G 2M1 Canada
Search for more papers by this authorMarcia Abbott M.D.
Department of Pathology and Laboratory Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4 Canada
Search for more papers by this authorElizabeth Brooks-Lim M.D.
Department of Pathology and Laboratory Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4 Canada
Department of Laboratory Medicine and Pathology, University of Alberta, 116 St. and 85 Ave, Edmonton, AB, T6G2R3 Canada
Office of the Chief Medical Examiner, 4070 Bowness Rd NW, Calgary, AB, T3B 3R7 Canada
Search for more papers by this authorCorresponding Author
Bamidele Adeagbo M.D.
Department of Pathology and Laboratory Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4 Canada
Department of Laboratory Medicine and Pathology, University of Alberta, 116 St. and 85 Ave, Edmonton, AB, T6G2R3 Canada
Office of the Chief Medical Examiner, 4070 Bowness Rd NW, Calgary, AB, T3B 3R7 Canada
Additional information and reprint requests:
Bamidele Adeagbo, M.D.
Forensic Pathologist, Assistant Chief Medical Examiner
Office of the Chief Medical Examiner
4070 Bowness Rd NW
Calgary, Alberta, T3B 3R7
Canada
E-mail: [email protected]
Search for more papers by this authorAbstract
Thromboembolic events in the context of carbon monoxide (CO) exposure have been well described in the literature. Six cases of clinically significant coronary thrombosis following CO exposure were previously reported. However, factors affecting the development of coronary thrombus in CO exposure are poorly understood, and the significance of this finding in a forensic context is not clear. This article discusses a case of coronary thrombosis found at autopsy following a death in which CO poisoning was suspected. A 67-year-old man was found dead in his garage with four vehicles with their ignition in the “on” position and their tanks empty. At autopsy, severe coronary atherosclerosis and an acute nonocclusive coronary thrombus were found. Given the dissimilarities among cases and the presence of CO exposure, it was suggested that the coronary artery thrombosis is likely due to the inherent prothrombotic mechanism of CO, the only common denominator in all the cases.
References
- 1Schmitt MW, Williams TL, Woodard KR, Harruff RC. Trends in suicide by carbon monoxide inhalation in King County, Washington: 1996-2009. J Forensic Sci 2011; 56(3): 652–5.
- 2Ernst A, Zibrak JD. Carbon monoxide poisoning. N Engl J Med 1998; 339(22): 1603–8.
- 3Yildirim C, Gunay N, Buyukaslan H, Kucukdurmaz Z, Bozkurt S. A case of carbon monoxide poisoning with thrombus in the heart: a case report. Inhal Toxicol 2005; 17(14): 797–801.
- 4Ryoo SM, Sohn CH, Kim HJ, Kwak MK, Oh BJ, Lim KS. Intracardiac thrombus formation induced by carbon monoxide poisoning. Hum Exp Toxicol 2013; 32(11): 1193–6.
- 5Rose JJ, Wang L, Xu Q, McTiernan CF, Shiva S, Tejero J, et al. Carbon monoxide poisoning: pathogenesis, management, and future directions of therapy. Am J Respir Crit Care Med 2017; 195(5): 596–606.
- 6Unlu M, Ozturk C, Demirkol S, Balta S, Malek A, Celik T, et al. Thrombolytic therapy in a patient with inferolateral myocardial infarction after carbon monoxide poisoning. Hum Exp Toxicol 2016; 35(1): 101–5.
- 7Teodoro T, Geraldes R, Pinho e Melo T. Symptomatic internal carotid artery thrombosis in acute carbon monoxide intoxication. Am J Emerg Med 2014; 32(6): 684.e5–6.
- 8Sevinc A, Savli H, Atmaca H. An interesting cause of pulmonary emboli: acute carbon monoxide poisoning. Clin Appl Thromb Hemost 2005; 11(3): 353–7.
- 9Chung WS, Lin CL, Kao CH. Carbon monoxide poisoning and risk of deep vein thrombosis and pulmonary embolism: a nationwide retrospective cohort study. J Epidemiol Community Health 2015; 69(6): 557–62.
- 10Grieb G, Simons D, Piatkowski A, Altiok E, Eppstein RJ, Bernhagen J, et al. Carbon monoxide intoxication versus myocardial infarction: an easy diagnosis? Burns 2011; 37(4): e29–31.
- 11Dziewierz A, Ciszowski K, Gawlikowski T, Rakowski T, Kleczynski P, Surdacki A, et al. Primary angioplasty in patient with ST-segment elevation myocardial infarction in the setting of intentional carbon monoxide poisoning. J Emerg Med 2013; 45(6): 831–4.
- 12Hsu PC, Lin TH, Su HM, Lee HC, Huang CH, Lai WT, et al. Acute carbon monoxide poisoning resulting in ST elevation myocardial infarction: a rare case report. Kaohsiung J Med Sci 2010; 26(5): 271–5.
- 13Dileo PA, Tucciarone M, Castro ER, Guerrero M. Late stent thrombosis secondary to carbon monoxide poisoning. Cardiovasc Revasc Med 2011; 12(1): 56–8.
- 14Öztürk S, Ayhan S, Dönmez İ, Erdem F, Erdem A. Very late stent thrombosis in a patient presenting with acute carbon monoxide poisoning. J Acad Emerg Med 2017; 8(2): 37–9.
- 15Nielsen VG, Hafner DT, Steinbrenner EB. Tobacco smoke-induced hypercoagulation in human plasma: role of carbon monoxide. Blood Coagul Fibrinolysis 2013; 24(4): 405–10.
- 16Gawlikowski T, Gomolka E, Piekoszewski W, Jawien W, Undas A. Acute CO poisoning is associated with impaired fibrinolysis and increased thrombin generation. Basic Clin Pharmacol Toxicol 2013; 112(5): 352–6.
- 17Olas B. Gasomediators (.NO, CO, and H(2)S) and their role in hemostasis and thrombosis. Clin Chim Acta 2015; 445: 115–21.
- 18Marius-Nunez AL. Myocardial infarction with normal coronary arteries after acute exposure to carbon monoxide. Chest 1990; 97(2): 491–4.
- 19Aronow WS. Effect of carbon monoxide on cardiovascular disease. Prev Med 1979; 8(3): 271–8.
- 20Petersen P, Godtfredsen J. Embolic complications in paroxysmal atrial fibrillation. Stroke 1986; 17(4): 622–6.
- 21Otterbein LE. The evolution of carbon monoxide into medicine. Respir Care 2009; 54(7): 925–32.
- 22Nakao A, Kimizuka K, Stolz DB, Neto JS, Kaizu T, Choi AM, et al. Carbon monoxide inhalation protects rat intestinal grafts from ischemia/reperfusion injury. Am J Pathol 2003; 163(4): 1587–98.
- 23Matsumoto H, Ishikawa K, Itabe H, Maruyama Y. Carbon monoxide and bilirubin from heme oxygenase-1 suppresses reactive oxygen species generation and plasminogen activator inhibitor-1 induction. Mol Cell Biochem 2006; 291(1–2): 21–8.
- 24Morisaki H, Katayama T, Kotake Y, Ito M, Handa M, Ikeda Y, et al. Carbon monoxide modulates endotoxin-induced microvascular leukocyte adhesion through platelet-dependent mechanisms. Anesthesiology 2002; 97(3): 701–9.
- 25Tucciarone M, Dileo PA, Castro ER, Guerrero M. Myocardial infarction secondary to carbon monoxide poisoning: an uncommon presentation of a common condition. Case report and review of the literature. Am J Ther 2009; 16(5): 462–5.
- 26Hocagil H, Tanrikulu CS, Ülker V, Kaya U, Koca L, Hocagil AC. Asymptomatic myocardial injury in a low level of carbon monoxide poisoning. J Acad Emerg Med 2015; 14(2): 91–3.
10.5152/jaem.2015.66588 Google Scholar
- 27Cha YS, Cha KC, Kim OH, Lee KH, Hwang SO, Kim H. Features and predictors of myocardial injury in carbon monoxide poisoned patients. Emerg Med J 2014; 31(3): 210–5.
- 28Chen SY, Chan CC, Su TC. Particulate and gaseous pollutants on inflammation, thrombosis, and autonomic imbalance in subjects at risk for cardiovascular disease. Environ Pollut 2017; 223: 403–8.
- 29Lin CW, Chen WK, Hung DZ, Chen YW, Lin CL, Sung FC, et al. Association between ischemic stroke and carbon monoxide poisoning: a population-based retrospective cohort analysis. Eur J Intern Med 2016; 29: 65–70.
- 30Nielsen PR, Gheorghe A, Lynnerup N. Forensic aspects of carbon monoxide poisoning by charcoal burning in Denmark, 2008-2012: an autopsy based study. Forensic Sci Med Pathol 2014; 10(3): 390–4.
- 31Vevelstad M, Morild I. Lethal methemoglobinemia and automobile exhaust inhalation. Forensic Sci Int 2009; 187(1–3): e1–5.
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