Toxic Myocardial Injury in a Patient With Coronary Atherosclerosis, Caused by Acute Poisoning With Gaseous Chlorine

Abstract

Acute chlorine gas poisoning leads to activation of the sympathetic nervous system and, as a consequence, dysfunction of the cardiovascular system (CVS). We report a clinical case of toxic myocardial injury with gaseous chlorine. In a man with coronary artery disease and polypathy, toxic myocardial injury mimicked acute coronary syndrome (ACS) and was accompanied by a large area of left ventricular microvascular dysfunction, which did not coincide with the areas of blood supply of altered coronary arteries; the dynamics of electrocardiographic changes resembled myocardial stunning in Takotsubo syndrome (TS). The effect of chlorine on CVS, features of clinical and instrumental diagnostics and differentiation of primary / secondary CT and ACS are discussed.

Keywords

• toxic myocardial injury
• takotsubo syndrome
• relapse
• chlorine gas
• instrumental diagnostics
• prognosis
• coronary artery disease
• myocardial infarction