Lifelong severe left ventricular dysfunction after lightning strike to the chest: A case report

Abstract

A unique case of lifelong severe segmental left ventricular dysfunction following a lightning strike to the chest of a 16-year-old boy. Despite normal coronary arteries and heart failure pharmacotherapy many years later, the appearance on ventriculography mimicked a Takotsubo-variant pathology. The patient, now 49-years-old, was playing soccer when he was struck by lightning in the central anterior chest 32 years ago, resulting in cardiogenic shock, cerebral hypoperfusion, hypoxic-induced brain injury and paraplegia, which left him wheelchair-bound. At age 46, he presented with fluid overload and was diagnosed with atrial flutter with rapid ventricular rates, along with severe apical impairment of left ventricular systolic function. Despite pharmacological management, including a heart failure-specific betablocker, diuretic therapy, therapeutic anticoagulation, and angiotensin / neprolysin inhibition, there was no improvement in his left ventricular systolic function over the subsequent years. Diagnostic coronary angiography revealed normal coronary arteries and a left ventriculogram showing apical dyskinesis, mimicking a Takotsubo-variant pathology. Spontaneous echocardiographic contrast was seen in the dyskinetic apex so anticoagulation was continued despite being in normal sinus rhythm. Discussion This case report highlights the potential lifelong consequences of lightning strikes to the chest, resulting in severe and persistent left ventricular dysfunction. The case also emphasises the importance of follow-up echocardiograms and anticoagulation therapy in patients with dyskinetic apex. As the origin and duration of the patient's cardiomyopathy depends on careful history taking, it is likely that the lightning strike caused permanent left ventricular dysfunction, masked for some years by the patient's immobility being wheelchair-bound.