Background: Carbon monoxide (CO) poisoning has deleterious cardiac effects which necessitate 
proper diagnoses and assessment using ECG and cardiac biomarkers; CKMB and troponinI. Human 
fatty acid-binding protein (H-FABP) recently used as a new cardiac marker as it is identifiable in 
serum by myocardial cell destruction. Aim of the work: To assess the role of H-FABP as an early 
predictor biomarker for CO induced cardiotoxicity. Patients and Methods: A prospective 
observational study was conducted on 25 adult (18-65years old) with diagnosis of acute CO poisoning
of both sex, admitted to Poison Control Center of Ain shams University Hospitals (PCCASUH) from 
November 2015 to April 2016. Patients were divided into; moderately intoxicated cases7 patients 
(Group 1) and severely intoxicated patients18 patients (Group 2). Cardiac assessment was done 
through ECG recording and analysis for (CKMB, CtnI and HFABP) serum level for all patients. This 
was done on (ER) (hour 0), after 6 hours and after 24 hours of admission. Results: The study 
recorded; chest pain 40%, syncope 60% and shock 28% in all patients which were more in group2
than that in group 1 and that was significant. Group2 developed more significant ischemic ECG 
changes than group 1. The mean CK-MB and troponin I level showed increase with high level at 
6th hour than 0hour and then decreased at 24th hour in both groups and that was statistically 
significant. Group 2 had significant higher mean serum H-FABP level compared to group 1 at 6th 
and 24th hour. Which tend to decrease continuously at 0hour, 6th hour and 24th hour in both groups 
this decrease with time was significant. In-addition, it showed decreasing sensitivity with time (0, 6 
and 24hours) in both groups and that was significant. As well as it showed increasing specificity with 
time (0, 6 and 24hours) in both groups and that also was significant. Conclusion and 
recommendations: Proper diagnosis and assessment of CO induced cardiac injury using ECG, 
cardiac enzymes, and even echocardiography is necessary. Measurement of H-FABP is useful 
sensitive indicator identifying early cardiac injury in CO poisoning with recommendation to be used 
as bedside test for acute CO poisoning patients presented with chest pain as it is more sensitive than
troponinI.