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Electrocardiographic changes in a case of electric shock
ELECTROCARDIOQBBPI[IIC
CHANGES
ELECTRIC
Ii% A CASE
OF
SHOCK”
LOUIS a. SIGLER, M.D.; AND J. JACOB &XISEIDER, BROOKLYN, ?;. Y.
M.D.
HE following case is reported bemuse of interesting electuocwdiographic changes which occurred in rapid succession following electric shock. The changes occurred wit.hout clinimlly detectable stmctural cardiac disease or lnyocardial insufficiencp. CASE REPORT old, was admitted to the Coney w. c., white male motorman, thirty-six years Island Hospital on the surgical service cf Dr. Earl J. BIilest On Sept. 17, 19%. His past history was likewise negative except fbr His family history was negative. an electric burn in 1920. While coupling two cars at about G :OO AX on Sept. 17, 1954, he received a mdden eIectric shock which rendered him unconscious for about two minutes. He was Examination showed a well-developed admitted to the hospital shortly thereafter. young male, who did not appear ill. His respirations were normal. There lvas no cyanosis. The head and neck showed nothing abnormal. The heart was normal in size; the rhythm was totally irregular; and the sounds TTere of good quality. No Both murmurs were heard. The lungs were clear, and the abdomen was negative. lower extremities shorved rather extensive second-degree burns. The total irregularity of the heart which he shomed on admission persisted for about three hours, and then there was a return to the normal sinus rhythm which continued throughout his stay in the hospital. At no time did he show any changes in the heart sounds, any signs of cardiac enlargement, or the slightest suggestion of myocardial insufficiency. His temperature was normal throughout with the exception of an occasional rise to 100” F., which could be attributed t6 inflammatory The laboratory findings reaction and absorption from the burns of the extremities. including blood chemistry, blood Wassermann reaction, blood count, urinalysis, and x-ray findings vvere negative. He was discharged on Oct. 15, 1934, in a perfectly normal condition. EZectrocardiog,~aphic Findings.-An S :30 A.M., shortly after his admission tion with a ventricular rate of about
electrocardiogram (Fig. 1) RRS taken at to the hospital. It s!lowed auricular fibrilla110 and a tendency toward left axis deviation. A’t 12 noon the same day there was regddr sinus rhythm with auricdar and ventrieular rates of about 75 per minute (Fig. 2). The P-R. con~luetion time was about O.lG sec. The QRS complex in Lead I Fvas of comparatively low voltage while that of Lead III was of higher voltage than in the previous tracing. At 9 :00 a.~. the following day the’ P-R, conduction time was inercased to 0.20 sec. ; the QRS c,omplexes were of much higher voltage; and there picas a marked degree of left axis deviation (Fig. 3). Lead I showed slight depression of the R-T segment and a negative T-wave, while in Lead III the T-:vave was positive with slight elevation of the S-T segment. The P-wave was markedly negative
:‘From the Department of Medicine, Coney Island Hospital, Bvxklyn, N. 7i. tWe are inclebtecl to Dr. Miles for the gl’ivilegc- of reporting this case. 236
SIiiLER
AND
SCHNEIDER
Figs.
:
l-6.
ELE~CTBIC
SHOCK
%7
in the same lead. At 1:OO P.M. the same day the P-B conduction time was reduced to 0.16 sec., and the P-wave in Lead III became almost isoelectric with tendency toward the diphasie (Fig. 4). The left a.xis deviation had entirely disappeared. The previously negative T-wave in Lea,d I had become definitely positive while the positive T-wave in Lead III became negative. The S-wave which was present in Lead Il. before had disappeared, and a large Q-wave appeared in that lead as well as in Lead III. The QRS voltage was definitely increased in Lead II. Four days later, on September 22, the tracing was essenCally normal except for the QRS voltage, which was slightly Iower than the accepted minimal normal (Fig. 5). There was a tendency toward left axis deviation, and the QRS and T complexes were similar to the first tracing. On October 6, sixteen days later, the tracing was similar to the one of September 22, with the QRS voltage reaching normal (Fig. 6). COMMENT
The tracings were all taken With the pat.ieklt in the same recumbent posture; shifting of the axis, as well as the changes in the complexes, cannot be attributed to any change in position of the patient. In the absence of any demonstrable clinical evidence of cardiac disease, the progressive, rapid electrocardiographic changes could be explained on the theory of disturbance in Lhe eleclzical conductivity of the heart induced by t,he extrinsic electric current. Judging from the changes it is quite conceivable that the temporary unconsciousness of the patient for two minutes immediately after receiving the electric shock might have been due to temporary ventricular fibrillation which soon subsided.
CHANGES
ELECTRIC
Ii% A CASE
OF
SHOCK”
LOUIS a. SIGLER, M.D.; AND J. JACOB &XISEIDER, BROOKLYN, ?;. Y.
M.D.
HE following case is reported bemuse of interesting electuocwdiographic changes which occurred in rapid succession following electric shock. The changes occurred wit.hout clinimlly detectable stmctural cardiac disease or lnyocardial insufficiencp. CASE REPORT old, was admitted to the Coney w. c., white male motorman, thirty-six years Island Hospital on the surgical service cf Dr. Earl J. BIilest On Sept. 17, 19%. His past history was likewise negative except fbr His family history was negative. an electric burn in 1920. While coupling two cars at about G :OO AX on Sept. 17, 1954, he received a mdden eIectric shock which rendered him unconscious for about two minutes. He was Examination showed a well-developed admitted to the hospital shortly thereafter. young male, who did not appear ill. His respirations were normal. There lvas no cyanosis. The head and neck showed nothing abnormal. The heart was normal in size; the rhythm was totally irregular; and the sounds TTere of good quality. No Both murmurs were heard. The lungs were clear, and the abdomen was negative. lower extremities shorved rather extensive second-degree burns. The total irregularity of the heart which he shomed on admission persisted for about three hours, and then there was a return to the normal sinus rhythm which continued throughout his stay in the hospital. At no time did he show any changes in the heart sounds, any signs of cardiac enlargement, or the slightest suggestion of myocardial insufficiency. His temperature was normal throughout with the exception of an occasional rise to 100” F., which could be attributed t6 inflammatory The laboratory findings reaction and absorption from the burns of the extremities. including blood chemistry, blood Wassermann reaction, blood count, urinalysis, and x-ray findings vvere negative. He was discharged on Oct. 15, 1934, in a perfectly normal condition. EZectrocardiog,~aphic Findings.-An S :30 A.M., shortly after his admission tion with a ventricular rate of about
electrocardiogram (Fig. 1) RRS taken at to the hospital. It s!lowed auricular fibrilla110 and a tendency toward left axis deviation. A’t 12 noon the same day there was regddr sinus rhythm with auricdar and ventrieular rates of about 75 per minute (Fig. 2). The P-R. con~luetion time was about O.lG sec. The QRS complex in Lead I Fvas of comparatively low voltage while that of Lead III was of higher voltage than in the previous tracing. At 9 :00 a.~. the following day the’ P-R, conduction time was inercased to 0.20 sec. ; the QRS c,omplexes were of much higher voltage; and there picas a marked degree of left axis deviation (Fig. 3). Lead I showed slight depression of the R-T segment and a negative T-wave, while in Lead III the T-:vave was positive with slight elevation of the S-T segment. The P-wave was markedly negative
:‘From the Department of Medicine, Coney Island Hospital, Bvxklyn, N. 7i. tWe are inclebtecl to Dr. Miles for the gl’ivilegc- of reporting this case. 236
SIiiLER
AND
SCHNEIDER
Figs.
:
l-6.
ELE~CTBIC
SHOCK
%7
in the same lead. At 1:OO P.M. the same day the P-B conduction time was reduced to 0.16 sec., and the P-wave in Lead III became almost isoelectric with tendency toward the diphasie (Fig. 4). The left a.xis deviation had entirely disappeared. The previously negative T-wave in Lea,d I had become definitely positive while the positive T-wave in Lead III became negative. The S-wave which was present in Lead Il. before had disappeared, and a large Q-wave appeared in that lead as well as in Lead III. The QRS voltage was definitely increased in Lead II. Four days later, on September 22, the tracing was essenCally normal except for the QRS voltage, which was slightly Iower than the accepted minimal normal (Fig. 5). There was a tendency toward left axis deviation, and the QRS and T complexes were similar to the first tracing. On October 6, sixteen days later, the tracing was similar to the one of September 22, with the QRS voltage reaching normal (Fig. 6). COMMENT
The tracings were all taken With the pat.ieklt in the same recumbent posture; shifting of the axis, as well as the changes in the complexes, cannot be attributed to any change in position of the patient. In the absence of any demonstrable clinical evidence of cardiac disease, the progressive, rapid electrocardiographic changes could be explained on the theory of disturbance in Lhe eleclzical conductivity of the heart induced by t,he extrinsic electric current. Judging from the changes it is quite conceivable that the temporary unconsciousness of the patient for two minutes immediately after receiving the electric shock might have been due to temporary ventricular fibrillation which soon subsided.