DISCUSSION
Electrical injury may cause various types of damage to the heart
structures, leading to necrotic scar, as seen on MRI scan and
endomyocardial specimen from fatal cases14-16.
The most common manifestation of cardiac involvement is arrhythmia. The
extent of the damage varies from harmless transient sinus tachycardia to
fatal ventricular arrhythmia and severe conduction abnormalities which
in some cases required permanent pacemaker7-12.
In the vast majority of cases, the onset of the injury is immediately
after the incident. In rare, cases, as in ours, the onset of the injury
may be after several hours, and its effect may last longer – from
minutes to several weeks5-6.
Appropriate recommendations regarding predisposition risk factors,
management and monitoring of patients who sustained electrical injury
has not been well defined, especially due to the prevalence of the
events and lack of long-term follow-up17.
Patients who were exposed to high voltage or have a history of loss of
consciousness, prolonged tetany, ECG abnormalities, extensive soft
tissue injury and an unwitnessed event, would require admission to the
hospital and should be monitored with telemetry for at least 24 hours
but recommendation relies mainly on expert opinion18.
Current type and pathway seems to play a major role in predicting
cardiac involvement and late sequel. Current that passes thought the
head to thorax is more likely to produce fatal arrhythmia and brain
injury19-21.