Delayed Lightning-Induced Cardiomyopathy: A Case Report of Reversible Myocardial Dysfunction

Abstract

Lightning strike is a rare natural phenomenon but can be fatal, with most deaths resulting from immediate cardiac arrest. Survivors may develop significant cardiac injuries ranging from acute arrhythmias to delayed cardiac complications, including lightning-induced cardiomyopathy (LIC). Although uncommon, LIC is a serious complication characterized by transient myocardial dysfunction following electrical injury, resembling stress-induced (Takotsubo) cardiomyopathy or myocardial stunning.

We report a case of a previously healthy young woman who presented after being struck by lightning. Although her initial troponin level was elevated, her ECG and echocardiogram were normal. Subsequently, she developed chest pain, and a repeat ECG showed T-wave inversions in the inferolateral leads. Coronary angiography was normal. On the second day, she became short of breath with clinical evidence of pulmonary edema; her pro-BNP level was elevated, and a repeat echocardiogram revealed impaired left ventricular systolic function with apical ballooning, characteristic of Takotsubo cardiomyopathy. She was diagnosed with delayed-onset LIC and was started on guideline-directed medical therapy for heart failure, achieving complete recovery.

This case highlights that lightning-induced cardiomyopathy can developed later after the lightning strike. Clinicians should observe the survivors for a new onset of symptoms of left ventricular dysfunction that suggest the diagnosis of LIC in lightning strike survivor. Repeat echocardiography assessment is curial even in initially normal echocardiogram and coronary angiogram as the condition is reversible and the patients have a high chance of recovery with appropriate management.