Lightning and the heart

Lightning and the heart

Lightning is a fearful natural phenomenon which can cause fatal injuries. But only 10% of the victims die immediately and 90% survive, sometimes with severe and permanent disabilities. Various cardiovascular complications associated with lightning injury has been described. McIntyre WF et al reported a case of lightning heart with a review of cardiovascular complications of lightning injury [1]. ECG changes like T wave inversion and prolongation of QT interval have been documented after lightning injury. Arrhythmias ranging from atrial fibrillation to ventricular fibrillation may occur. Myocardial ischemia and contusion as well as Takotsubo cardiomyopathy (apical ballooning syndrome or stress cardiomyopathy) have been described. The mechanisms proposed for cardiac injury with lightning include direct thermal damage, catecholamine surge, coronary artery spasm, generalized vascular injury and arrhythmias secondary to ischemia. Cardiogenic pulmonary edema can occur as a result of myocardial dysfunction. Renal failure as a consequence of rhabdomyolysis could also contribute to volume overload and pulmonary edema.

Inappropriate therapies from cardiac implantable electronic devices (CIED), pericardial disease, aortic injury, aortic dissection and cardiomyopathy associated with ventricular failure are the other cardiac effects of lightning strikes [2]. Those developing cardiorespiratory arrest may have favourable outcomes even after prolonged resuscitation in young and previously healthy victims. Appropriate therapy of an implantable cardioverter defibrillator (ICD) can also be life saving. In a case report, a 75 year old male electrocuted by lightning strike was rescued by ICD shock [3]. In another case, lightning strike to a shower house caused electromagnetic interference which was erroneously detected as ventricular fibrillation and two inappropriate ICD shocks delivered [4].

Lightning strikes occur when the potential difference between the clouds and ground objects is greater than 30,000 Volts so that they can overcome the electrical resistance of the atmospheric air. The currents generated range from 30,000 to 100,000 Amperes and last from 0.001 to 0.1 seconds. It is estimated that 1.4 billion lightning flashes occur in a year globally as per satellite data [2].

References

1. William F McIntyre, Christopher S Simpson, Damian P Redfearn, Hoshiar Abdollah, Adrian Baranchuk. The lightning heart: a case report and brief review of the cardiovascular complications of lightning injury. Indian Pacing Electrophysiol J. 2010 Sep 5;10(9):429-34.
2. Christophides T, Khan S, Ahmad M, Fayed H, Bogle R. Cardiac Effects of Lightning Strikes. Arrhythm Electrophysiol Rev. 2017 Aug;6(3):114-117. doi: 10.15420/aer.2017:7:3. PMID: 29018518; PMCID: PMC5610732.
3. Kondur AK, Afonso LC, Berenbom LD, Lakkireddy DR. Implantable cardioverter defibrillators save lives from lightning-related electrocution too! Pacing Clin Electrophysiol. 2008 Feb;31(2):256-7. doi: 10.1111/j.1540-8159.2007.00980.x. PMID: 18233984.
4. Anderson DR, Gillberg JM, Torrey JW, Koneru JN. Lightning induced inappropriate ICD shock: an unusual case of electromagnetic interference. Pacing Clin Electrophysiol. 2012 Jun;35(6):e159-62. doi: 10.1111/j.1540-8159.2010.02914.x. Epub 2010 Sep 30. PMID: 20883513.