Human carbofuran intoxication with myocardial injury mimicking acute myocardial infarction

摘要

A 51-year-old man with a history of hypertension drank about 50 mL of pesticide, containing carbofuran, after an argument with his family. He was found drowsy, weak, and unable to talk about 15 minutes after the argument. No chest tightness, diaphoresis, dyspnea, or chest pain were noted. He was brought to the hospital immediately, presenting with tachycardia (112 beats/min), hypertension (192/96 mmHg), and tachypnea (26 breaths/min). Physical examination revealed drowsy and agitated consciousness (Glasgow coma scale of E3V2M5) and small pupil size, but no obvious airway secretion or abnormality in breath sound, heart sound or abdomen. The laboratory examination revealed decreased cholinesterase level (3.67 kU/L). Electrocardiography showed diffuse ST-T segments depression over precordial leads (Fig. 1A). Gastric lavage with activated charcoal and atropine infusion were given. He developed hypoxemic respiratory failure 2 hours later, requiring intubation for mechanical ventilation. After admission to the intensive care unit, adequate hydration and atropine infusion were prescribed for suspected carbofuran intoxication. Elevated cardiac enzyme levels (creatine phosphokinase, 242 IU/L; creatine kinase-MB, 15.7 ng/mL; and troponin-I, 2.04 ng/mL) were noted, so dual antiplatelets and heparinization were given because acute myocardial infarction (AMI) could not be excluded. However, the cardiac enzyme levels reached a peak within a few hours, and the follow-up electrocardiography showed interval disappearance of the ST-T segments depression (Fig. 1B). Bedside echocardiography showed adequate systolic function without valvular abnormality or wall motion defect. Tachyarrhythmia-related injury was less likely because tachycardia soon subsided at the emergency department. Stress cardiomyopathy was also not favored because echocardiography showed normal wall motion. Therefore, carbofuran-related cardiotoxicity, rather than AMI, tachyarrhythmia or stress cardiomyopathy, was concluded, so clopidogrel and heparin were discontinued. Cardiac catheterization was suggested but refused because of no further associated cardiac symptoms and signs. He was soon discharged uneventfully without obvious sequelae in 1 week.