Acute Coronary Syndrome After High-Voltage Electrocution: A Shocking Diagnosis.

BACKGROUND: The most common cardiac consequences of high-voltage electrocution include arrhythmias and myocardial injury from supply-demand mismatch. Acute coronary syndrome from plaque rupture and thrombosis is a less commonly reported sequela of high-voltage electrocution. CASE SUMMARY: We present a case of high-voltage electrocution causing chest pain due to a non-ST-segment elevation myocardial infarction with angiographic evidence of plaque rupture and coronary thrombosis. DISCUSSION: This case highlights electrocution as a potential trigger of plaque rupture and type 1 myocardial infarction, challenging the recognized spectrum of myocardial injury in this setting. The proposed mechanism of high-voltage electrocution causing acute plaque rupture involves multiple insults, including sympathetic hyperactivity, endothelial injury, and a prothrombotic environment, leading to vulnerable plaque destabilization and thrombotic occlusion. TAKE-HOME MESSAGE: Persistent chest pain and resting wall motion abnormalities on echocardiography after high-voltage electrocution should prompt early invasive coronary angiography given the potential for electrocution to precipitate plaque rupture.