The Case Files: Carbon Monoxide Intoxication Disguised as Atrial Fibrillation

By Punam Patel, DO, & Steven Sattler, DO A 62-year-old Caucasian woman presented to the emergency department with palpitations that had started that morning. She had no history of similar symptoms and denied medications, allergies, and alcohol or drug use. She had quit smoking cigarettes 13 years earlier. She initially denied all other symptoms, but staff overheard the patient and spouse complaining of headaches. They reported that they had been awakening with headaches and fatigue since moving into a new home a week earlier. Vital signs upon arrival were respiration, 20 breaths per minute; heart rate, 156 beats per minute; blood pressure, 113/78 mm Hg, and temperature 97F orally. Physical exam showed a well-appearing woman in no acute distress with a rapid irregularly irregular heartbeat. The rest of the physical exam was normal. An electrocardiogram showed AF with rapid ventricular response, a PVC, and a prolonged QTc. (Figure 1.) Laboratory results including complete blood count, basic metabolic panel, cardiac enzymes, and TSH were unremarkable. The COHb level was 22.2% of total hemoglobin. A chest radiograph was normal. The patient was started on high-flow oxygen therapy. The heart rate was controlled with Diltiazem 15 mg IVP followed by Diltiazem 90 mg PO. The patient’s symptoms resolved with a repeat electrocardiogram that displayed normal sinus rhythm. (Figure 2.) A hyperbaric therapy-equipped institution was consulted, but we decided not to transfer her becau...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research