Article

Cardiovascular effects of lightning strikes.

Loyola University-Chicago, Maywood, Illinois.
Journal of the American College of Cardiology (impact factor: 14.16). 02/1993; 21(2):531-6. DOI:10.1016/0735-1097(93)90699-2 pp.531-6
Source: PubMed

ABSTRACT The purpose of this study was to investigate the effects of lightning strikes on the cardiovascular system.
A lightning strike can attack its victims in one of three ways: direct hit, splash or ground strike. The cardiovascular system can be affected directly by mechanical or electrical trauma during a direct hit or can be indirectly affected through effects on the total body with extensive catecholamine release or autonomic stimulation. Reported effects include hypertension, tachycardia, nonspecific electrocardiographic (ECG) changes including prolongation of the corrected QT (QTc) interval, transient T wave inversion and myocardial necrosis with creatine kinase-MB (CK-MB) fraction release.
Nineteen victims from five separate lightning strikes were studied over a 2-month period. Each patient was evaluated by serial ECG, CK-MB determinations and echocardiography.
The early (0 to 72 h) effects of lightning were demonstrated on the ECG by ST segment elevation consistent with acute current of injury, prolonged QTc interval with direct hits and nonspecific ST and T wave changes. On echocardiography, segmental or global ventricular dysfunction was seen, and pericardial effusion was also detected. During the intermediate (3- to 14-day) period, new and often marked ECG changes consistent with pericarditis or ischemia were seen. No new echocardiographic changes were detected, however, and the early abnormalities including severe left ventricular dysfunction with cardiogenic shock have reversed. The late (1 to 12 months) period revealed only one patient with long-term sequelae (recurrent pericarditis that persisted for 5 months).
Unless both entrance and exit sites are limited to the lower limbs, direct and splash lightning strikes cause myocardial damage as assessed by abnormal serum enzyme determinations or abnormal echocardiographic findings. Only direct hits resulted in echocardiographic abnormalities or a prolonged QTc interval. The degree of myocardial injury can be severe with left and right ventricular ejection fraction < 15% and can be reversible.

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    Article: Severe stunned myocardium after lightning strike.
    Jaime Rivera, Karla Alejandra Romero, Octavio González-Chon, Eduardo Uruchurtu, Manlio Fabio Márquez, Milton Guevara
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    Critical Care Medicine 02/2007; 35(1):280-5. · 6.33 Impact Factor
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    Article: Injuries, sequelae, and treatment of lightning-induced injuries: 10 years of experience at a swiss trauma center.
    Carmen A Pfortmueller, Yang Yikun, Monika Haberkern, Erwin Wuest, Heinz Zimmermann, Aristomenis K Exadaktylos
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    ABSTRACT: Principals. Lightning is one of the most powerful and spectacular natural phenomena. Lightning strikes to humans are uncommon but can cause devastating injuries. We analyzed lightning-related admissions to our emergency department from January 2000 to December 2010 to review and highlight the main features of lightning-related injuries. Methods. All data were collected prospectively and entered in the emergency department' database (Qualicare Switzerland) and retrospectively analyzed. Results. Nine patients with lightning-related injuries presented to our emergency department. Four were female, and five were male. The most common site of injury was the nervous system (6 out of 9 patients) followed by the cardiovascular system (5 out of 9 patients). The third most common injuries occurred to the skin (3 out of 9 patients). Four of the patients had to be hospitalized for further observation. Conclusion. Reports of lightning strikes and related injuries are scarce. The establishment of an international register would therefore benefit the understanding of their injury patterns and facilitate specific treatment.
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Keywords

cardiovascular system
 
corrected QT
 
creatine kinase-MB
 
ECG changes consistent
 
electrical trauma
 
extensive catecholamine release
 
global ventricular dysfunction
 
ground strike
 
lightning strike
 
lightning strikes
 
new echocardiographic changes
 
nonspecific electrocardiographic
 
nonspecific ST
 
one patient
 
prolonged QTc interval
 
recurrent pericarditis
 
separate lightning strikes
 
serial ECG
 
T wave changes
 
ventricular ejection fraction
 

R Lichtenberg