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The assessment of QT intervals in acute carbon monoxide poisoning [Anatol J Cardiol]
Anatol J Cardiol. 2009; 9(5): 397-400

The assessment of QT intervals in acute carbon monoxide poisoning

Birgül Yelken1, Belkıs Tanrıverdi1, Ferda Çetinbaş1, Dilek Memiş4, Necdet Süt5
1Department of Anesthesiology and Intensive Care, Faculty of Medicine, Osmangazi University, Eskişehir
2Department of Anesthesiology and Intensive Care, Faculty of Medicine, Osmangazi University, Eskişehir
3Department of Anesthesiology and Intensive Care, Faculty of Medicine, Osmangazi University, Eskişehir
4Department of Anesthesiology and Intensive Care Faculty of Medicine, Trakya University, Edirne
5Department of Biostatistics, Faculty of Medicine, Trakya University, Edirne

Objective: Carbon monoxide (CO) poisoning is known to cause myocardial toxicity and life threatening arrhythmias. QT interval measured from electrocardiogram is an indirect measure of the heterogeneity of ventricular repolarization, which may contribute to ventricular arrhythmias. The purpose of the study was to investigate whether the carboxyhemoglobin (COHb) level may be related to the changes of QT, corrected QT (QTc), QT dispersion (QTd), corrected Qtd (QTdc) and cardiac enzymes during carbon monoxide poisoning. Methods: We conducted an observational study; 104 patients who had been diagnosed with CO intoxication were included in the study. Measurement of QT, QTc, QTd and QTdc intervals were performed form electrocardiogram on admission, 24 and 48 hours after admission. Cardiac enzymes were measured at each time-point. The myocardial perfusion scan was determined in all patients 1 week after admission. Results: The QT interval level in 24h was significantly higher than admission level (p<0.001), additionally QTc interval levels in 24h and 48h were significantly lower than admission levels (p<0.001 and p<0.001, respectively). Carboxyhemoglobin level only significantly correlated with QT intervals (r=-0.288; p=0.019), troponin T (r=-0.297; p=0.007), and creatine kinase MB levels (r=0.262; p=0.020). As a result of ROC analysis the QT interval level was significantly powerful parameter to predict COHb (p=0.022). Conclusion: Our data indicate COHb level correlated with QT intervals and cardiac enzymes. Clinicians should possibly avoid QT prolonging drugs and carefully monitor the QT, QTc, QTdc intervals in patients at high risk of cardiac disability due to high levels of COHb after CO poisoning.

Keywords: Carbon monoxide poisoning, carboxyhemoglobin, QT intervals, predictive value of tests


Akut karbonmonoksit zehirlenmelerinde QT intervallerinin değerlendirilmesi

Birgül Yelken1, Belkıs Tanrıverdi1, Ferda Çetinbaş1, Dilek Memiş4, Necdet Süt5
1Department of Anesthesiology and Intensive Care, Faculty of Medicine, Osmangazi University, Eskişehir
2Department of Anesthesiology and Intensive Care, Faculty of Medicine, Osmangazi University, Eskişehir
3Department of Anesthesiology and Intensive Care, Faculty of Medicine, Osmangazi University, Eskişehir
4Department of Anesthesiology and Intensive Care Faculty of Medicine, Trakya University, Edirne
5Department of Biostatistics, Faculty of Medicine, Trakya University, Edirne

Amaç: Karbonmonoksit zehirlenmelerinin miyokard toksisitesine ve ciddi aritmilere yol açtığı bilinmektedir. Elektrokardiyografide (EKG) ölçülen QT intervalleri, aritmilere neden olan ventrikül repolarizasyonundaki düzensizliğin bir göstergesidir. Bu çalışmanın amacı, karbonomonoksit zehirlenmelerinde, karboksihemoglobin seviyesinin (COHb) QT, düzeltilmiş QT (QTc), QT dispersiyonu (QTd), düzeltilmiş QTd (QTdc) intervallerindeki değişikliklerle ve kardiyak enzimlerle ilişkisi olup olmadığını araştırmaktır. Yöntemler: Karbonmonoksit zehirlenmesi tanısı konan 104 olgu çalışma kapsamına alındı. QT, QTc, QTd ve QTdc intervallerinin ölçümü olguların hastaneye kabulunde, 24 saat ve 48 saat sonra yapıldı. Eş zamanlı kardiyak enzim ölçümleri yapıldı. Bulgular: Gözlemsel çalışma QT intervalleri 24. saatte, kabuldeki değerlerine göre daha yüksek (p<0.001), QTc intervalleri ise 24 ve 48. saatlerde kabuldekine göre daha düşük bulundu (p<0.001, p<0.001). Karboksihemoglobin düzeyi sadece QT intervali (r=-0.288; p=0.019), troponin T (r=-0.297; p=0.007) ve kreatin kinaz MB (r=0.262; p=0.020) düzeyleri ile korelasyon gösterdi. ROC analizinde QT süresi COHb düzeyin anlamlı öngördürücüsü olarak bulundu (p=0.022). Sonuç: Çalışmamız karboksihemoglobin düzeyinin QT intervalleri ve kardiyak enzimlerle korele olduğunu göstermiştir. Karbonmonoksit zehirlenmelerinde, yüksek COHb düzeylerine bağlı oluşabilecek kardiyak problemler göz önüne alınarak, yüksek riskli hastalarda QT, QTc, QTd, QTdc intervallerinin monitorize edilmesi ve QT uzamasına yol açabilecek ilaçlardan kaçınılması gerektiği sonucuna varılmıştır.

Anahtar Kelimeler: Karbonmonoksit zehirlenmesi, karboksihemoglobin, QT intervalleri, testlerin prediktif değeri


Birgül Yelken, Belkıs Tanrıverdi, Ferda Çetinbaş, Dilek Memiş, Necdet Süt. The assessment of QT intervals in acute carbon monoxide poisoning. Anatol J Cardiol. 2009; 9(5): 397-400


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