RESUMO
INTRODUCTION: Modern cardiovascular implantable electronic devices (CIEDs) have mechanisms that prevent damage from external electric shocks, and malfunction following accidental electrocution is rare. However, the effects of lightning injuries in patients with CIEDs are uncertain. CASE PRESENTATION: A 74-year-old man with a dual-chamber pacemaker due to complete heart block was struck by a lightning while farming. He had no serious injury at the time and sought medical evaluation 1 month later, when he presented with asymptomatic bradycardia. Device interrogation suggested major battery and lead damage, requiring extraction and subsequent placement of a new pacing system. DISCUSSION: While a previous report depicted pacing threshold elevation without extensive device impairment, our patient presented with major damage to the whole pacing system. The factors contributing to these divergent outcomes are unclear. Differences in injury mechanism, pacemaker model, and the pattern of electric current dispersion within the device may each play a part in this discrepancy.
RESUMO
Triangular QRS-ST-T waveform, also known as "shark fin pattern", is an ECG presentation of ST segment elevation myocardial infarction with a unique wave composed by the QRS complex, the ST segment, and the T wave. It is associated with very poor prognosis and recently has been shown to be more common in patients with left main coronary artery (LMCA) involvement. Nevertheless, data supporting this correlation is scant. Herein we present a case of a patient with LMCA subtotal occlusion who developed a transient triangular QRS-ST-T waveform after an initial ECG had shown subendocardial ischemia. Electrocardiographic findings resolved spontaneously, and the patient was successfully treated without major complications. It is uncertain what caused the change between patterns.