Development of ST Elevation Myocardial Infarction and Atrial Fibrillation after an Electrical Injury

Acute myocardial infarction due to accidental electrocution — A case report of a 26-year-old African male patient

We report a case of fatal myocardial infarction (MI) after electrocution in a 26-year-old male patient without cardiovascular risk factors. The patient was admitted to the Emergency Department of the University Clinics of Lubumbashi for management of accidental electrocution on a high-voltage power line. The admission ECG showed lesions consistent with myocardial infarction. Despite treatment, the patient died 30 minutes after admission.

[STEMI mimics : ST elevations on ECG: alternative diagnoses to acute coronary occlusion]

BACKGROUND

The electrocardiogram (ECG) is an integral part of basic emergency medical diagnosis and preoperative evaluation. In cases of ST elevation myocardial infarction (STEMI) immediate treatment is mandatory after correlation of ischemic symptoms with the ECG pattern. However, there are also ECG patterns that can imitate STEMI, possibly resulting in the true underlying diagnosis being missed and inappropriate therapy being initiated.

OBJECTIVES

This paper provides an overview of the most important diagnoses that can imitate STEMI on ECG.

MATERIAL AND METHODS

A literature search was carried out to determine the most important differential diagnoses of ST elevation on ECG. These STEMI mimics are discussed in detail and their relevance for emergency medicine is explained.

RESULTS

This article provides an overview of differential diagnoses that should be known in emergency medicine when assessing an ECG with ST elevations.

CONCLUSION

Good knowledge of the ECG patterns presented here can support decision-making in emergency medicine.

Patient outcomes after electrical injury - a retrospective study

INTRODUCTION

People exposed to electrical injuries are often admitted to hospital for observation. Current evidence suggests that patients who have a normal ECG on admission after a low-voltage injury, with no loss of consciousness or initial cardiac arrest may be discharged home after a short observation time. Currently, there are no established standards for the duration of monitoring after electric shock, but 24 h of observation is the most commonly adopted approach. We carried out a retrospective study of patients admitted after electrical injuries to determine the in-hospital outcomes and 30-day mortality in these patients.

METHODS

We performed a chart review of all patients with electrical injuries admitted to Østfold Hospital, Norway between the years 2001 and 2019, to determine in-hospital and 30-day mortality and the frequency of various cardiac and non-cardiac complications.

RESULTS

Mean age of 465 included patients (88% males) was 31 years. Of all injuries, 329 (71%) were work-related, 17 (3.7%) involved loss of consciousness. Furthermore, 29/437 (6.6%) were high voltage (> 1000 V), and 243/401 (60.6%) were transthoracic injuries. 369 (79.4%) were discharged same day. None of the admitted patients died in hospital nor did any die within 30 days of admission, yielding a 30-day mortality of 0% (95% CI 0-0.8). At admission troponin was elevated in three (0.6%) patients, creatinine kinase (CK) in 30 (6.5%) and creatinine in six (1.3%). Electrocardiogram (ECG) abnormalities were described in 85 (18%) patients. No serious arrhythmias were detected. When comparing high- vs low-voltage or transthoracic vs other injuries, there were no significant differences between most of the outcomes, except for more ECG abnormalities in the transthoracic group, whereas more patients had elevated CK, and fewer discharged the same day in high-voltage injuries.

CONCLUSION

No in-hospital nor 30-day mortality or serious arrhythmias were encountered in those who were assessed, regardless of the type of injury. Troponin and creatinine were rarely elevated. It seems that conscious patients admitted with a normal ECG following a low-voltage injury may safely be discharged home after a quick clinical assessment including ECG.

Late myocardial sequelae of electrical injury

Electrocution poses serious complications seen mostly at the time of the event. Physicians and patients are usually not aware of the progressive nature and its potentially delayed effect as demonstrated in our case. We believe that a risk stratification model should be designed to guide physicians for proper management.