A 53-year-old male was admitted to the Intensive Care Unit with cardiogenic shock secondary to severe carbon monoxide poisoning. Treatment was started with 100% O2 due to initial carboxyhemoglobin levels of 25%. Echocardiography was performed due to sustained hypotension despite resuscitation and vasoactive drugs (Appendix B enclosed video, left), revealing severe biventricular dysfunction with an estimated cardiac output of 1.8 L/min that gradually recovered in the subsequent 48 h with inotropic support in the form of dobutamine (Appendix B enclosed video, right). The initial ECG tracing evidenced no known right bundle block (Fig. 1, image A) that reverted after the first 24 h, evolving towards subendocardial injury on the anterolateral surface and posterior ischemia in those territories (Fig. 1, images B and C). The brain CT scan evidenced symmetrical bilateral hypodensity in the globus pallidus (Fig. 2) – this image being characteristic of carbon monoxide poisoning due to the high iron content and high sensitivity to hypotension.

Figure 1

Figure 2