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	Since this article does not have an abstract, we have provided the first 115 words of the full text and any section headings.

To the Editor: The study by Mr Henry and colleagues¹ concluded that there is an association between moderate to severe carbon monoxide (CO) exposure and myocardial injury. However, in addition to CO, cyanide exposure should be considered in individuals who present in extremis or with a severe metabolic acidosis following fire exposure.² It is not stated in the article which of the patients had fire exposure. It would be valuable to know which patients in this cohort were exposed to fire, which had lactic acidosis, which had elevated cyanide levels, and which patients received sodium thiosulfate antidote therapy, to determine whether a link can be made between cyanide and myocardial injury.

Financial Disclosures: None reported.

Gar Ming Chan, MD
garchan@pol.net
North Shore University Hospital
Department of Emergency Medicine
Manhasset, NY

1. Henry CR, Satran D, Lindgren B, Adkinson C, Nicholson CI, Henry TD. Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning. JAMA. 2006;295:398-402. FREE FULL TEXT 2. Baud FJ, Barriot P, Toffis V, et al. Elevated blood cyanide concentrations in victims of smoke inhalation. N Engl J Med. 1991;325:1761-1766. ABSTRACT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;295:2601.

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