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Urban Angina, Urban Arrhythmias: Carbon Monoxide and the Heart

Sandra M. Walden, MD; and Sidney O. Gottlieb, MD
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Requests for Reprints: Sidney O. Gottlieb, MD, Division of Cardiology, The Johns Hopkins Hospital, 601 N. Wolfe Street, Baltimore, MD 21205.

Johns Hopkins University School of Medicine
Baltimore, MD 21205

Ann Intern Med. 1990;113(5):337-338. doi:10.7326/0003-4819-113-5-337
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Does atmospheric air pollution affect the heart? The article by Sheps and colleagues (1) in this issue provides additional evidence that exposure to inhaled carbon monoxide produces direct adverse effects on the heart by facilitating frequent and complex ventricular ectopy in patients with coronary artery disease. While it is known that very high levels of carbon monoxide exposure can cause myocardial ischemia and dysfunction even in normal hearts, recent evidence now indicates that exposure to carbon monoxide at low levels, producing venous carboxyhemoglobin levels in the range commonly found in urban dwellers and certain high-risk occupations (for example, tunnel workers,


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