Karbonmonoksit İntoksikasyonuna Sekonder Gelişen Persistan Sol Dal Bloğu Vakası Ve Literatür İncelemesi
Özet
Bu vaka sunumunda, banyoda bilinci kapalı halde bulunan ve karbonmonoksit intoksikasyonu tanısı konulan 26 yaşında bir erkek hastanın klinik süreci incelenmiştir. Hastanın ilk başvurusunda karboksihemoglobin düzeyi %39.4 ve troponin değeri 372.7 ng/L olarak saptanmıştır. Hiperbarik oksijen tedavisinin ardından hastanın karboksihemoglobin seviyesi %1.6'ya gerilemiş, konuşmadaki hafif yavaşlama dışında fizik muayenesi normal olarak değerlendirilmiştir. Yapılan ekokardiyografide ejeksiyon fraksiyonu %50 ve global hipokinezi saptanırken, koroner BT anjiyografisinde koroner arterlerin normal olduğu görülmüştür. Hastanın 6, 12 ve 18. aylarda yapılan takiplerinde sol ventrikül ejeksiyon fraksiyonunun normale döndüğü, ancak elektrokardiyografisinde (EKG) saptanan sol dal bloğunun kalıcı olarak devam ettiği gözlenmiştir. Literatürde yer alan benzer vakaların neredeyse tamamında karbonmonoksit zehirlenmesine sekonder gelişen sol dal blokları geçici bir seyir izlerken, bu vakada kardiyak fonksiyonlar düzelse bile sol dal bloğunun kalıcı (persistan) kalması, olguyu diğer literatör örneklerinden ayıran en önemli özellik olmuştur. Bu durumun hastanın karbonmonoksit gazına uzun süre maruz kalmasından kaynaklanabileceği düşünülmektedir.
This case report examines the clinical course of a 26-year-old male patient who was found unconscious in a bathroom and diagnosed with carbon monoxide intoxication. Upon admission, the patient's carboxyhemoglobin level was 39.4% and the troponin level was 372.7 ng/L. Following hyperbaric oxygen therapy, the carboxyhemoglobin level decreased to 1.6%, and the physical examination was normal except for a slight slowness in speech. Echocardiography revealed an ejection fraction of 50% and global hypokinesia, while coronary CT angiography showed normal coronary arteries. During follow-ups at 6, 12, and 18 months, the patient's left ventricular ejection fraction returned to normal; however, the left bundle branch block detected on the electrocardiogram (ECG) persisted. While almost all similar cases in the literature exhibit transient bundle branch blocks secondary to carbon monoxide poisoning, this case is distinguished by the persistence of the left bundle branch block despite the normalization of cardiac functions. This permanent condition is thought to be associated with prolonged exposure to carbon monoxide.
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