Reversibility of myocardial edema and regional wall motion abnormalities in a non-Takotsubo-like pattern in a lightning strike survivor detected by cardiac MRI – a case report

Abstract Background Despite an increasing number of case reports, lightning strikes in humans remain a rare occurrence. The associated complications range from burns and transient unconsciousness to severe cardiac consequences such as arrhythmias, cardiomyopathies and cardiogenic shock until death. Case overview A 26 year old patient was struck by lightning. After temporary loss of consciousness, he got admitted to hospital. Serious injuries were excluded by computed tomography (CT). A transthoracic echocardiography (TTE) showed a normal cardiac function without structural or functional alterations. During the first hours of monitoring, non-sustained ventricular tachycardia occurred and an increase of cardiac enzymes was noted. A repeat TTE showed new hypokinesia of the septal wall and a mild impairment of global left ventricular function. Coronary artery disease was ruled out by CT. A stress-induced cardiomyopathy was suspected, although the morphologic criteria of classic Takotsubo cardiomyopathy were not met. Cardiac MRI confirmed septal wall motion abnormalities (WMA) and showed septal myocardial edema without evidence of scarring. The patient was discharged with a wearable cardioverter-defibrillator. A repeat cardiac MRI showed complete resolution of WMA and myocardial edema. Arrhythmic events did not occur. In summary of the findings, we interpret the reversible structural changes as a correlate of a contusio cordis after lightning strike. Discussion Cardiovascular involvement due to lightning strikes is diverse and does not always met established diagnostic criteria. This case illustrates that structural myocardial changes may be transient without any sequelae. Cardiac MRI is an important diagnostic tool in differential diagnosis and for risk stratification.