Background: The use of waterpipe in shisha lounges is popular among young people, but it has a risk of carbon monoxide poisoning and can lead to serious cardiac problems.
Case Description: A 26-year-old man presented to the emergency department with chest pain, dyspnea and syncope after working in a shisha lounge. Blood gas analysis showed carbon monoxide intoxication and an increased lactate level. Troponin-I measurement was normal. Ventricular arrhythmias on the monitor were the impetus for further cardiac analysis. Echocardiography showed a reduced left ventricular ejection fraction (27%). The acute treatment consisted of high dose oxygen, followed by normalization of carboxyhemoglobin and lactate levels. The ventricular extrasystoles were reduced with beta-blockers. There was improvement of the left ventricular ejection fraction (42%) within a week, but PVC-induced cardiomyopathy remained a possible underlying condition.
Conclusion: The use of waterpipe can cause carbon monoxide intoxication, which may be accompanied by arrhythmias and cardiomyopathy.
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