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Ansari Ramandi MM, Valizadeh N, Moezzi A, Ghoddusi M, Hatami F. Chest Pain in a Young Male with Carbon Monoxide Poisoning and Substance Abuse: A Case Report and Literature Review. ARYA ATHEROSCLEROSIS 2023; 19:58-62. [PMID: 38883570 PMCID: PMC11066783 DOI: 10.48305/arya.2023.11795.2447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/08/2023] [Indexed: 06/18/2024]
Abstract
BACKGROUND Carbon monoxide (CO) poisoning is the leading cause of poisoning-related deaths in the United States. In addition, myocardial infarction (MI) due to CO poisoning in a young, healthy adult is rare. On the other hand, smokeless tobacco, processed in various forms, is a controversial coronary heart disease (CHD) risk factor. CASE REPORT In this study, we describe a 29-year-old man who presented with acute chest pain following a night of smoking tobacco and using smokeless tobacco in the presence of carbon monoxide poisoning. ST-segment elevation was observed on an electrocardiogram, and echocardiography revealed akinesia. In addition, cardiac markers were elevated. In this particular instance, thrombolytic therapy demonstrated successful outcomes. CONCLUSIONS We believe the case and discussion could shed light on the emergency department management of such individuals. We advise clinicians to consider the possibility of coronary heart disease in carbon monoxide poisoning patients and to obtain a baseline electrocardiogram and cardiac markers.
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Affiliation(s)
- Mohammad Mostafa Ansari Ramandi
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Niloufar Valizadeh
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Ali Moezzi
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Mohamadyousef Ghoddusi
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Farbod Hatami
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
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Hung MY, Wu YH, Bamodu OA, Chen X, Lin YK, Hu P, Chang NC, Pang JHS, Yeh CT. Activation of the monocytic α7 nicotinic acetylcholine receptor modulates oxidative stress and inflammation-associated development of coronary artery spasm via a p38 MAP-kinase signaling-dependent pathway. Free Radic Biol Med 2018; 120:266-276. [PMID: 29609021 DOI: 10.1016/j.freeradbiomed.2018.03.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Smoking and high-sensitivity C-reactive protein (hs-CRP) are risk factors for coronary artery spasm (CAS), which is characterized by the increased interleukin-6 (IL-6) level and monocyte counts; however, limited data are available regarding the role of cigarette-embedded nicotine in the modulation of monocytic inflammatory activity in CAS. APPROACH We investigated and elucidated the putative roles and associations of nicotine, monocytic IL-6, α7 nicotinic acetylcholine receptor (α7-nAChR), and CRP in CAS development. RESULTS We demonstrated that a significantly increased α7-nAChR (p = 0.001) and IL-6 (p = 0.0036) messenger RNA (mRNA) expression in the serum of patients with CAS. Serum hs-CRP levels exhibited a strong positive correlation with the monocytic mRNA expression of α7-nAChR (r = 0.71, p < 0.001) and IL-6 (r = 0.49, p = 0.006). The α7-nAChR and IL-6 expression levels of the CAS group were also positively correlated (r = 0.63, p < 0.001). Compared with the untreated controls, THP-1 cells and patient-derived monocytes treated with different concentrations of CRP displayed significantly increased expression levels of α7-nAChR mRNA and protein (p = 0.0054), in a dose-dependent manner. We also demonstrated that compared with the IL-6 expression elicited by CRP alone (p = 0.0489), the CRP-induced rise in monocytic IL-6 mRNA and protein expression in the presence of nicotine (p = 0.0002), is mediated by α7-nAChR activation and the deregulation of the human p38 mitogen-activated protein kinases (MAPK) signaling pathway. CONCLUSIONS Our data demonstrate that the elevated monocytic IL-6 and α7-nAChR mRNA and protein expression levels are associated with the interaction between nicotine and CRP positively modulates CAS development. Our study suggests the potential role of α7-nAChR mRNA and/or protein expression as a diagnostic biomarker for CAS.
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Affiliation(s)
- Ming-Yow Hung
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Yi-Hong Wu
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Oluwaseun Adebayo Bamodu
- Department of Hematology and Oncology, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan; Department of Medical Research and Education, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan
| | - Xi Chen
- International Medical Center, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Yen-Kuang Lin
- Biostatistics Research Center, Taipei Medical University, Taipei, Taiwan
| | - Patrick Hu
- International Cardiovascular Institute, Las Vegas, Nevada, USA; Department of Cardiology, Riverside Medical Clinic, Riverside, California, USA
| | - Nen-Chung Chang
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jong-Hwei Su Pang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan.
| | - Chi-Tai Yeh
- Department of Medical Research and Education, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan.
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