Seizures may also occur. It is estimated that one third of lightning victims suffer primary cardiac arrest. Secondary cardiac arrest is the critical mortality factor. Seventy-five percent of those who die as a result of electrification by lightning are thought to have suffered secondary arrest. Nonspecific ECG changes are often present, ST elevation and T wave inversion being the most common.
Myocardial infarction is uncommon with lightning injury.
Serum creatine kinase-MB can give a false positive result because of the electrical interaction with skeletal muscle. The superficial nature of lightning burns is due to the brief flashover effect of the electrical energy. There are four patterns of lightning burns. Feathering is highly characteristic of lightning. It is a nonblanching, reddish-brown fern pattern which disappears in several days.