European Journal of Molecular & Clinical Medicine

Abstract

Background: Myocarditis is an inflammatory condition involving the myocardium (heart muscle). Myocarditis is characterized by variety of symptoms ranging from fatigue, difficult breathing and rapid heart rate to sudden death from fatal arrhythmias. Many poisons are potent cardiotoxin and their ingestion leads to myocardial damage. Due to myocardial damage there are release of cardiac specific markers like trop T, Trop I and CPKMB. Myocardial injury is due to chemical myocarditis. Hence the patients may have outcome due to complication of myocarditis in the form of pump failure, rhythm disturbance etc. In the present study myocardial damage was assessed by electrocardiographic changes and CPKMB values. ECG changes along with raised CPKMB levels after ingestion of poison were noticed.
Objectives: We sought (1) To study the role of biochemical markers (particularly CPK-MB) of myocarditis in poisoning cases admitted in the poison ward of a tertiary hospital. (2) To study the ECG manifestation of patients presenting with various poisons causing myocarditis. (3) To study the Echocardiography findings in poisons causing myocarditis.
Material and Methods: This prospective study was carried out on total 104 cases with complain of  ingestion of poison known to cause myocarditis, admitted in Poison Ward, of a tertiary hospital.  ECG, Biochemical (CPK-MB) and Echocardiographic findings of these patients were studied.  All the patients who developed chemical myocarditis (on the basis of clinical suspicion) underwent battery of tests ECG, CPK-MB in addition to routine investigations and the patients with abnormal ECG findings and or elevated CPK-MB levels were further investigated with Echocardiography during the period of hospitalization.
Results: Majority of patients 79(75.9%) of poisoning causing chemical myocarditis were in between age group of 15-34 yrs. CPKMB was elevated in 99(95.1%) patients out of 104 patients of chemical myocarditis and 78(75%) patients showed abnormal ECG findings, in which majority of patients were of  Hair Dye 25(78.1%), Organophosphorus 26(78.7%), Aluminum Phosphide 18(72%) and Rat killer poisoning 7(77.7%); remaining 26 patients showed normal ECG findings. The most common abnormal Echocardiographic finding was Pericardial effusion 10(9.6%) followed by Valvular pathology 6(5.7%), Hypokinesia of the left ventricular wall 3(2.8%), left ventricular systolic dysfunction 1(0.96%) and prolapse of anterior mitral leaflet 2(1.92%).
Conclusion: Abnormal ECG findings and elevated CPK-MB level are correlating well with severity of cardiotoxicity of the poisons in the present study. Echocardiographic findings are not correlating with the severity of cardiotoxicity due to lack of serial monitoring by echocardiography. Major role of Echocardiography comes into play in hemodynamically unstable patients so that their treatment can be monitored.