Citation

Franzius C, Meyer-Hofmann H, Lison AE. Dtsch. Med. Wochenschr. 1997; 122(13): 400-406.

Vernacular Title

Myokardinfarkt und Rhabdomyolyse nach einem Hochspannungsunfall mit erfolgreicher

Affiliation

Medizinische Klinik III, Zentralkrankenhaus St.-Jürgen-Strasse, Bremen.

Copyright

(Copyright © 1997, Georg Thieme Verlag)

DOI

10.1055/s-2008-1047629

PMID

9138913

Abstract

HISTORY AND CLINICAL FINDINGS: A 25-year-old man working as varnisher near a power transmission line sustained a 110,000 V shock. Immediately cardiopulmonary resuscitation (CPR) of the pulseless and unconscious man by lay personnel was continued after 5 minutes by an emergency physician. Normal cardiac rhythm was established after 25 electrical defibrillating shocks and 25 minutes of CPR. He was then taken to hospital by helicopter. On admission the intubated and ventilated patient was precariously stable on high doses of catecholamines. His blood pressure was 100/60 mm Hg, the heart rate 110/min. There were current marks on both hands and the left foot; part of the right pectoral muscle was contracted bulge-like. Creatine kinase activity in serum was raised to 2070 U/l (MB fraction 174 U/l). The ECG showed significant ST-elevations in V2-V4. TREATMENT AND COURSE: At first most attention was paid to stabilising cardiac function. The activity of serum creatine kinase rose to a maximum of 13,881 U/l during the first 6 hours. To prevent renal failure caused by the marked rhabdomyolysis large fluid volumes were administered while intracardiac pressures were monitored via a right-heart catheter and urinary alkalization obtained. The precordial leads of the ECG showed an evolution of changes as in an anteroseptal infarction, the latter confirmed echocardiographically by hypo- and akinesia of the anterior wall. The patient was successfully extubated after 32 hours and was symptom-free without cerebral impairment after 13 days. As subsequent coronary angiography was normal the previous signs of myocardial infarction were most likely caused by current-induced vasospasms. CONCLUSIONS: Immediate resuscitation measures after high-voltage shock can prevent physical and mental damage. The rare diagnosis of acute myocardial infarction requires careful consideration because the usual diagnostic criteria of enzyme abnormalities and symptoms cannot be used.

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