Cardiovascular complications after lightning strike injury

Author(s): Indiresha Iyer, Abiodun Idowu

Cloud to ground Lightning strikes is the second leading cause of weather-related deaths in the USA, recently accounting for approximately 28 deaths annually. Lightning strike injuries are more common in the summer months especially in the south- eastern and southern parts of the USA. Outdoor lightning strikes can result in death. Deaths due to lightning strikes are approximately 4 times more common in males and the average age of death about 37 years. Two-thirds of lightning associated deaths occur in the first hour of injury and are generally due to arrhythmias or respiratory failure. Patients hospitalized after Lightning Strike Injury (LSI) need to be monitored for cardiovascular events such as cardiac arrest, arrhythmias (ventricular, atrial and brady arrhythmias), myocardial damage, pericardial and aortic complications. There may be some gender differences in cardiac manifestations after lightning strike injury with one study reporting atrial arrhythmias predominantly in men and conduction blocks predominantly in women. The postulated mechanisms for cardiovascular manifestations include direct myocardial cell damage from the massive Direct Current (DC) current, electric arrhythmias due to depolarization mechanisms, severe vasospasm from catecholaminergic surge, blast injury and medullary dysfunction due to lightning injury of the brain. Cardiac arrest, Ventricular arrhythmias, Electrocardiography (ECG) pattern of ST-Segment Elevation Myocardial Infarction (STEMI) are associated with increased odds for mortality and myocardial contusion has been described on autopsy in those with cardiac manifestations. Reverse triage, Aggressive Cardiopulmonary Resuscitation and Standard (ACLS) protocols are recommended for the management of these patients. Technological advances in weather forecasting, public awareness and public policy are important in prevention of lightning strike injuries.