High-Voltage Electrical Injury Presenting with ST-Segment Elevation and Transient Myocardial Dysfunction without Obstructive Coronary Artery Disease.
Muhammed Erzurum, Vedat Erdinç, Tuğba Kapanşahin et al.
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Case in brief
A 38-year-old man suffered cardiopulmonary arrest after exposure to a 25,000-volt electrical current. His ECG showed inferolateral ST-segment elevation, cardiac biomarkers were markedly elevated, and echocardiography found an LVEF of 35%, regional hypokinesia, and moderate mitral regurgitation. Emergency coronary angiography showed no significant obstructive disease. Within 24 hours, the ST changes nearly resolved and ventricular function and regional wall motion normalized, with mitral regurgitation becoming trivial. Despite cardiac recovery, he developed dialysis-requiring acute kidney injury, neurological deterioration, suspected pneumonia, and refractory septic shock, and died on hospital day 10.
What made this case unusual
The infarction-like ECG and transient regional myocardial dysfunction followed high-voltage injury despite angiography showing no significant obstructive coronary disease; cardiac abnormalities resolved rapidly.
Diagnostic / clinical pearl
After high-voltage electrical injury, ST-segment elevation and transient ventricular dysfunction can occur without obstructive coronary disease. Interpret these findings in the context of the injury and angiographic results.