# When lightning strikes the heart: a rare injury with features of non‑ST elevation myocardial infarction – a case report

## TL;DR

A 31-year-old man suffered a lightning strike that caused ECG changes resembling a heart attack, but no actual heart damage was found.

## Contribution

This case report highlights the rare occurrence of lightning-induced ECG changes mimicking non-ST elevation myocardial infarction.

## Key findings

- A lightning strike caused ECG changes and elevated troponin-I without evidence of atherosclerosis.
- The patient showed ST depression and inverted T waves, typical of NSTEMI, but was treated conservatively.
- Echocardiography showed left ventricular hypertrophy and mild diastolic dysfunction but no major cardiac damage.

## Abstract

Injuries from lightning strikes are infrequent but potentially life-threatening, mainly caused by indirect electrical injuries. Although various organ systems can be involved, the effects of electric current on the cardiovascular system can manifest as electrocardiographic (ECG) changes, elevated cardiac-specific enzymes, and cardiac and respiratory arrest, although rare. This case report aims to describe the ECG changes that occur due to lightning strikes and resemble the features of non-ST elevation myocardial infarction (NSTEMI).

A 31-year-old man with no history of cardiovascular disease risk factors other than being an active smoker presented to the emergency department after being unconscious for 15 min due to a lightning strike while digging a grave. He complained of headache, tingling in the extremities, and general weakness. The physical examination found no burns or bruises. The initial ECG examination showed inferior ST depression with elevated troponin-I, which led to the diagnostic features of NSTEMI. When a repeat ECG examination was performed the next day, an inverted T wave was found in the inferior leads. Echocardiographic examination revealed only concentric left ventricular hypertrophy and mild diastolic dysfunction without kinetic abnormalities. Because it was assumed that the NSTEMI features were not due to an atherothrombotic process, the patient was treated conservatively without worsening his condition.

Lightning strikes can cause a range of cardiac injuries, from mild ECG changes to fatal damage. Early recognition of lightning injury syndrome and close monitoring of complications through signs and symptoms, ECG, cardiac enzymes, and echocardiography are crucial for improving patient outcomes.