Myocardial Injury after Electric Accident: Dynamic Change of Cardiac Biomarkers Was the Important Key for Diagnosis of This Serious Complication

Le Ngoc Hung^1,2*, Truong Duong Tien^1,2

¹Biochemistry Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam.
²Cho Ray-Phnom Penh Hospital, Phnompenh, Cambodia.

DOI: 10.4236/jbm.2015.37009                

Abstract

This report was aimed to record the value of dynamic change of cardiac biomarkers in diagnosis of serious myocardial injury in electrical shock. One female patient was admitted to the emergency department, Cho Ray-Phnom Penh Hospital, Phnom Penh, Cambodia after electrical accident, in cardiopulmonary arrest status with no pulse, no breath. The cardiopulmonary resuscitation was done immediately as intra-tracheal ventilation, fluid replacement with NaCl 0.9%, urine alkalinization therapy with Natribicarbonate 4.2%, sympathomimetic agents as adrenaline and nor-adrenaline, and IV nutrition with glucose 30%. Cardiac biomarkers were repeated many times over 12 hours after admission. Troponin I increased 1000 times higher from 0.02 ng/mL on admission to 20.1 ng/mL within 12 hours. CK-MB increased from 55.4 to 227 U/L after 2 hours (normal value: <16 U/L). CPK (normal value: 90 - 140 U/L) changed quickly from 99 U/L on admission to a very high level as 9681 U/L after 12 hrs. The CK-MB/CPK index (defined as CK-MB × 100/CPK, unit as %) changed from 55.9% to 2.7%, respectively by time. In conclusion, the very quick dynamic change of cardiac biomarkers suggested the presence of serious myocardial injury among multiple organs injured in electric shock.

Keywords

Serious Myocardial Injury, Electric Shock, Troponin I, Dynamic Change, Cardiac Biomarkers

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Greaves, K. and Crake, T. (1998) Cardiac Troponin T Does Not Increase after Electrical Cardioversion for Atrial Fibrillation or Atrial Flutter. Heart, 80, 226-228. http://dx.doi.org/10.1136/hrt.80.3.226
[2]	Piechota, W., Gielerak, G., Ryczek, R., Kaźmierczak, A., Bejm, J. and Piechota, W. (2007) Cardiac Troponin I after External Electrical Cardioversion for Atrial Fibrillation as a Marker of Myocardial Injury—A Preliminary Report. Kardiologia Polska, 65, 664-669.
[3]	Cemin, R., Rauhe, W., Marini, M., Pescoller, F. and Pitscheider, W. (2005) Serum Troponin I Level after External Electrical Direct Current Synchronized Cardioversion in Patients with Normal or Reduced Ejection Fraction: No Evidence of Myocytes Injury. Clinical Cardiology, 28, 467-470. http://dx.doi.org/10.1002/clc.4960281005
[4]	John, B.A., Bena, J.F., Stayner, L.T., Halperin, W.E. and Park, R.M. (2003) External Cause Specific Summaries of Occupational Fatal Injuries. Part I: An Analysis of Rates. American Journal of Industrial Medicine, 43, 237-250. http://dx.doi.org/10.1002/ajim.10184
[5]	Haberal, M.A. (1995) An Eleven-Year Survey of Electrical Burn Injuries. Journal of Burn Care & Rehabilitation, 16, 43-48. http://dx.doi.org/10.1097/00004630-199501000-00008
[6]	Rosen, C.L., Adler, J.N., Rabban, J.T., Sethi, R.K., Arkoff, L., Blair, J.A., et al. (1999) Early Predictors of Myoglobinuria and Acute Renal Failure Following Electrical Injury. The Journal of Emergency Medicine, 17, 783-789. http://dx.doi.org/10.1016/S0736-4679(99)00084-0
[7]	Knayzer, B., Abramov, D., Natalia, B., Tovbin, D., Ganiel, A. and Katz, A. (2007) Atrial Fibrillation and Plasma Troponin I Elevation after Cardiac Surgery: Relation to Inflammation-Associated Parameters. Journal of Cardiac Surgery, 22, 117-123. http://dx.doi.org/10.1111/j.1540-8191.2006.00366.x
[8]	Thielmann, M., Massoudy, P., Neuhäuser, M., Knipp, S., Kamler, M., Marggraf, G., Piotrowski, J. and Jakob, H. (2005) Risk Stratification with Cardiac Troponin I in Patients Undergoing Elective Coronary Artery Bypass Surgery. European Journal Cardio-Thoracic Surgery, 27, 861-869. http://dx.doi.org/10.1016/j.ejcts.2005.01.043
[9]	Housinger, T.A., Green, L., Shahangian, S., Saffle, J.R. and Warden, G.D. (1985) A Prospective Study of Myocardial Damage in Electrical Injuries. Journal of Trauma-Injury Infection & Critical Care, 25, 122-124. http://dx.doi.org/10.1097/00005373-198502000-00005
[10]	Spies, C. and Trohman, R.G. (2006) Narrative Review: Electrocution and Life-Threatening Electrical Injuries. Annals of Intern Medicine, 145, 531-537. http://dx.doi.org/10.7326/0003-4819-145-7-200610030-00011
[11]	Celebi, A., Gulel, O., Cicekcioglu, H., Gokaslan, S., Kututcularoglu, G. and Ulusoy, V. (2009) Myocardial Infarction after Electric Shock: A Rare Complication. Cardiology Journal, 16, 362-364.
[12]	Lown, B., Neuman, J., Amarasingham, R. and Berkovits, B.V. (1962) Comparison of Alternating Current with Direct Electroshock across the Closed Chest. A merican Journal of Cardiology, 10, 223-233. http://dx.doi.org/10.1016/0002-9149(62)90299-0
[13]	Solem, L., Fischer, R.P. and Strate, R.G. (1977) The Natural History of Electrical Injury. Journal of Trauma-Injury Infection & Critical Care, 17, 487-492. http://dx.doi.org/10.1097/00005373-197707000-00001
[14]	Homa, S., Gillam, L.D. and Weyman, A.E. (1990) Electrocardiographic Observations in Survivors of Acute Electrical Injury. Chest, 97, 103-105. http://dx.doi.org/10.1378/chest.97.1.103
[15]	Guntheti, B.K., Khaja, S. and Singh, U.P. (2012) Pattern of Injuries due to Electric Current. Journal of Indian Academy of Forensic Medicine, 34, 44-48.