Severe stunned myocardium after lightning strike.
OBJECTIVE
To report the development of myocardial stunning and severe heart failure after lightning strike with total recovery of function.


METHODS
Case report.


METHODS
Coronary care unit at Medica Sur Clinic, Mexico.


METHODS
A 42-yr-old woman who was hit by lightning developed rapid and progressive hemodynamic deterioration manifested by cardiogenic shock that required invasive monitoring. Twenty-four hours after the strike, intravenous levosimendan and intra-aortic balloon pump were initiated because the patient demonstrated no significant response to management with conventional inotropic agents. Two days later, echocardiographic signs of systolic and diastolic dysfunction improved markedly. Dual-isotope-imaging myocardial perfusion testing with technetium-99m-sestamibi and thallium-201, performed 9 days after admission, showed normal perfusion and normal left ventricular systolic function. The patient exhibited complete recovery of function. The exact mechanism of abnormal contractility in the absence of direct electrofulguration is unknown but may be explained by release of oxygen free radicals, proteolysis of the contractile apparatus, and cytosolic overload of intracellular calcium, followed by reduced myofilament sensitivity to calcium. These abnormalities are consistent with stunned myocardium.


CONCLUSIONS
Lightning strike may cause serious contractile dysfunction in the absence of irreversible myocardial injury, but the exact mechanism of this phenomenon remains unknown. We propose that lighting strike can cause myocardial stunning resulting in severe but reversible left ventricular dysfunction. The patient's recovery was facilitated by support treatment including administration of levosimendan, which increases the intracellular sensitivity to calcium, a mechanism disturbed in patients with myocardial stunning.
Rivera
Jaime
J
Department of Cardiology, Medica Sur Clinic, Mexico City, Mexico.
Romero
Karla Alejandra
KA
González-Chon
Octavio
O
Uruchurtu
Eduardo
E
Márquez
Manlio Fabio
MF
Guevara
Milton
M
D000328:Adult; D002316:Cardiotonic Agents / Q000627:therapeutic use; D015984:Causality; D003422:Critical Care / Q000379:methods; D018450:Disease Progression; D004452:Echocardiography; D004562:Electrocardiography; D004830:Epilepsy, Tonic-Clonic / Q000209:etiology; D005080:Exercise Test; D005260:Female; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use; D007423:Intra-Aortic Balloon Pumping; D015168:Lightning Injuries / Q000150:complications*; D008991:Monitoring, Physiologic; D017682:Myocardial Stunning / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D011724:Pyridazines / Q000627:therapeutic use; D019275:Radiopharmaceuticals; D020127:Recovery of Function; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000209:etiology; D000077464:Simendan; D017256:Technetium Tc 99m Sestamibi; D013793:Thallium; D018487:Ventricular Dysfunction, Left / Q000209:etiology
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D019275:Radiopharmaceuticals; D000077464:Simendan; C027549:thallium chloride; D017256:Technetium Tc 99m Sestamibi; D013793:Thallium