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. 1994 Oct;70(828):699–702. doi: 10.1136/pgmj.70.828.699

Unstable angina and exposure to carbon monoxide.

M V Balzan 1, J M Cacciottolo 1, S Mifsud 1
PMCID: PMC2397798  PMID: 7831163

Abstract

Inhalation of small amounts of carbon monoxide diminishes the pain threshold in patients with stable angina pectoris. The aim of this study was to identify and describe patients who had been exposed unknowingly to toxic inhalations of this gas and subsequently presented to hospital with a clinical picture of unstable angina. Blood carboxyhaemoglobin levels of 104 patients referred with unstable angina to a coronary care unit were determined on admission. The likely source of carbon monoxide was identified in all patients. Three patients had definite carbon monoxide intoxication. Another five patients had evidence of minor exposure. When the three cases with carbon monoxide poisoning were excluded, the mean carboxyhaemoglobin level was 2.5% (+/- 1.3) for smokers (n = 30) and 0.6% (+/- 0.5) for non-smokers (n = 71). Use of fossil fuel combustion in an enclosed environment was responsible for the three most serious intoxications and one of the minor cases. We suggest that a number of patients admitted for coronary care with unstable angina may have significant carbon monoxide poisoning. This intoxication is often overlooked by attending physicians with the result that high concentration oxygen therapy is not administered, when it is in fact a necessary part of treatment.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allred E. N., Bleecker E. R., Chaitman B. R., Dahms T. E., Gottlieb S. O., Hackney J. D., Pagano M., Selvester R. H., Walden S. M., Warren J. Short-term effects of carbon monoxide exposure on the exercise performance of subjects with coronary artery disease. N Engl J Med. 1989 Nov 23;321(21):1426–1432. doi: 10.1056/NEJM198911233212102. [DOI] [PubMed] [Google Scholar]
  2. Anderson E. W., Andelman R. J., Strauch J. M., Fortuin N. J., Knelson J. H. Effect of low-level carbon monoxide exposure on onset and duration of angina pectoris. A study in ten patients with ischemic heart disease. Ann Intern Med. 1973 Jul;79(1):46–50. doi: 10.7326/0003-4819-79-1-46. [DOI] [PubMed] [Google Scholar]
  3. Anderson R. F., Allensworth D. C., DeGroot W. J. Myocardial toxicity from carbon monoxide poisoning. Ann Intern Med. 1967 Dec;67(6):1172–1182. doi: 10.7326/0003-4819-67-6-1172. [DOI] [PubMed] [Google Scholar]
  4. Aronow W. S. Aggravation of angina pectoris by two percent carboxyhemoglobin. Am Heart J. 1981 Feb;101(2):154–157. doi: 10.1016/0002-8703(81)90658-x. [DOI] [PubMed] [Google Scholar]
  5. Aronow W. S. Effect of passive smoking on angina pectoris. N Engl J Med. 1978 Jul 6;299(1):21–24. doi: 10.1056/NEJM197807062990105. [DOI] [PubMed] [Google Scholar]
  6. Aronow W. S., Isbell M. W. Carbon monoxide effect on exercise-induced angina pectoris. Ann Intern Med. 1973 Sep;79(3):392–395. doi: 10.7326/0003-4819-79-3-392. [DOI] [PubMed] [Google Scholar]
  7. Ayres S. M., Giannelli S., Jr, Mueller H. Myocardial and systemic responses to carboxyhemoglobin. Ann N Y Acad Sci. 1970 Oct 5;174(1):268–293. doi: 10.1111/j.1749-6632.1970.tb49795.x. [DOI] [PubMed] [Google Scholar]
  8. Grace T. W., Platt F. W. Subacute carbon monoxide poisoning. Another great imitator. JAMA. 1981 Oct 9;246(15):1698–1700. [PubMed] [Google Scholar]
  9. SHAFER N., SMILAY M. G., MACMILLAN F. P. PRIMARY MYOCARDIAL DISEASE IN MAN RESULTING FROM ACUTE CARBON MONOXIDE POISONING. Am J Med. 1965 Feb;38:316–320. doi: 10.1016/0002-9343(65)90186-5. [DOI] [PubMed] [Google Scholar]
  10. Scharf S. M., Thames M. D., Sargent R. K. Transmural myocardial infarction after exposure to carbon monoxide in coronary-artery disease. Report of a case. N Engl J Med. 1974 Jun 11;291(2):85–86. doi: 10.1056/NEJM197407112910208. [DOI] [PubMed] [Google Scholar]
  11. Stewart R. D., Baretta E. D., Platte L. R., Stewart E. B., Kalbfleisch J. H., Van Yserloo B., Rimm A. A. Carboxyhemoglobin levels in American blood donors. JAMA. 1974 Aug 26;229(9):1187–1195. [PubMed] [Google Scholar]
  12. Théroux P., Ouimet H., McCans J., Latour J. G., Joly P., Lévy G., Pelletier E., Juneau M., Stasiak J., deGuise P. Aspirin, heparin, or both to treat acute unstable angina. N Engl J Med. 1988 Oct 27;319(17):1105–1111. doi: 10.1056/NEJM198810273191701. [DOI] [PubMed] [Google Scholar]
  13. Wald N., Idle M., Smith P. G. Carboxyhaemoglobin levels in smokers of filter and plain cigarettes. Lancet. 1977 Jan 15;1(8003):110–112. doi: 10.1016/s0140-6736(77)91702-0. [DOI] [PubMed] [Google Scholar]
  14. Winter P. M., Miller J. N. Carbon monoxide poisoning. JAMA. 1976 Sep 27;236(13):1502–1502. [PubMed] [Google Scholar]

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