High-Voltage Electrical Injury Presenting With ST-Segment Elevation and Transient Myocardial Dysfunction Without Obstructive Coronary Artery Disease

Electrical injury may cause various cardiac complications, including electrocardiographic (ECG) changes that mimic acute myocardial infarction. We present a 38-year-old man who developed cardiopulmonary arrest after exposure to a 25,000-volt electrical current. The admission ECG showed inferolateral ST-segment elevation, raising suspicion for acute myocardial infarction. Cardiac biomarkers were markedly elevated, and transthoracic echocardiography demonstrated a left ventricular ejection fraction (LVEF) of 35% with inferoposterolateral wall hypokinesia accompanied by moderate mitral regurgitation. Emergency coronary angiography demonstrated no significant obstructive coronary artery disease. The post-coronary angiography ECG showed greater than 50% resolution of the ST-segment elevation. A 24-hour follow-up ECG demonstrated near-complete resolution of the ST-segment abnormalities, while repeat echocardiography showed complete recovery of left ventricular systolic function, resolution of the previously detected regional wall motion abnormalities, and regression of mitral regurgitation to a trivial degree. Although ventricular function normalized within 24 hours, the patient subsequently developed dialysis-requiring acute kidney injury, neurological deterioration, suspected pneumonia, and refractory septic shock and died on hospital day 10. This case highlights that high-voltage electrical injury may present with ST-segment elevation despite the absence of obstructive coronary artery disease, accompanied by reversible myocardial dysfunction, emphasizing the importance of considering ST-segment elevation myocardial infarction (STEMI) mimics in the differential diagnosis.

Keywords: Electrical injury, myocardial injury, ST-segment elevation, transient myocardial dysfunction