Acute myocardial infarction in a young man after heat exhaustion

Garcı́a-Rubira, Juan C.; Aguilar, Javier; Romero, Dolores

doi:10.1016/0167-5273(94)02204-v

Cited by 23 publications

(15 citation statements)

References 6 publications

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“…Garcia-Rubira, et al reported a 33-year-old victim of heat exhaustion who suffered from chest pain and whose ECG revealed new Q waves, suggesting myocardial infarction of the inferior wall. 7) Nevertheless, diffuse ST elevation in heat stroke unrelated to a territory of the coronary artery and that recovered without Q wave formation has not been reported.…”

Section: Discussionmentioning

confidence: 99%

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A Case of Severe Heat Stroke With Abnormal Cardiac Findings

et al. 2005

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SUMMARYWe document serial changes in the electrocardiogram (ECG) and myocardial markers in a case of severe heat stroke treated with cooling procedures. A 23-year-old comatose male with heat stroke was presented in the emergency room. The condition of the patient was complicated by hepatic failure, rhabdomyolysis, acute renal failure, and cardiac abnormalities. ECG revealed diffuse ST-T elevation; serum levels of myocardial markers were remarkably high and diffuse hypokinesis was observed on the echocardiogram. Cooling procedures, including applying cold vapor to the patient's skin, a gastric lavage with cold water, and an intravenous cold fluid infusion were not successful. Since multiple organ damage (heart, liver, central nervous system, and kidney) was evident, we utilized continuous hemodialysis and hemofiltration, using cold dialysate for efficient cooling. The patient recovered from the multiple organ damage and was removed from the intensive care unit 14 days after the onset. The cardiac abnormalities had normalized within several days without any damage to the myocardium. Q waves were not detected in any lead in the ECG. When interpreting ST-T elevation in the ECG of a heat stroke patient, caution should be used so as to not misdiagnose it as an acute myocardial infarction. (Int Heart J 2005; 46: 543-550) Key words: Heat stroke, Electrocardiography, Multiple organ failure, Myocardium HEAT stroke is an acute thermoregulatory failure that often results from exposure to high temperatures.1) The diagnosis of heat stroke is usually based on central nervous system dysfunction and a rectal temperature of 41°C or higher, as well as occasional multi-organ damage and dysfunction.2,3) Heat stroke can be exercise induced (exertional) or non-exercise induced (classic), and occurs when heat gain exceeds heat loss from the skin by radiation, convection, or evaporation. 4)Several cardiac complications have been documented in heat stroke cases, 5,6) and certain nonspecific ECG changes, including ST-T elevation, have been described. ST-T elevation is rare in heat stroke and is sometimes attributed to corFrom the

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Section: Discussionmentioning

confidence: 99%

“…7) Echocardiographic findings and myocardial marker levels in heat stroke have also been reported. 8) However, to the best of our knowledge, there have not been any reports concerning serial changes in ECG and myocardial marker levels after successful cooling.…”

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confidence: 99%

A Case of Severe Heat Stroke With Abnormal Cardiac Findings

et al. 2005

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“…Recruits who came into training in good fitness were at lower risk for developing EHI, probably because good aerobic fitness provides increased cardiac output, permitting greater blood flow to the skin and muscles needed for thermoregulation and exercise reducing the risk of EHI (1), (24). Maximal oxygen uptake per unit body mass (m!/minkg), expressed as V02max, is the laboratory measure of aerobic fitness (14).…”

Section: Discussionmentioning

confidence: 99%

“…Sesso et al (2000) also found a 2.5 fold increase in risk for cardiovascular disease for men < 60 years of age and a MAP > 97 mmHg compared to men in the same age group with a MAP < 88 mmHg (24). Based on these findings, cut-points for MAP were determined to be > 95 for severe EHI and < 95 MmHg for mild EHI.…”

Section: Miura Et Al (2001)mentioning

confidence: 99%

“…Once individuals are diagnosed as heatstroke victims, are they more susceptible to other types of illnesses either acute or chronic? Heatstroke is known to cause damage to tissue of the heart, kidney and liver (13), (24), (43), (61). One or more of these systems may be compromised because of "over heating", possibly placing these individuals at higher risk of developing chronic heart, pulmonary, kidney and/or liver diseases that may possibly lead to premature death.…”

Section: Chronic Heat Disordersmentioning

confidence: 99%

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Risk Factors and Mortality in Relation to Heat Illness Severity

Wallace¹

2003

PsycEXTRA Dataset

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Public reporting burden for (his coliectbn of Information is estimated to average 1 hour per response, Including the time for reviewing instructions, searcliing existing data sources, galfieting and maintaining ttie data needed, and completing and reviewing ttie collection of information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing Uiis burden, to Washington Headquarters Services, Cireclotate for infomialion Operations and Reports, t215 Jefferson Davis Highway, Suite 1204, Artinglon, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. AGENCY USE ONLY (Leave blank). REPORT DATE JUNE 2003 3. REPORT TYPE AND DATES COVERED TECHNICAL REPORT TITLE AND SUBTITLE RISK FACTORS AND MORTALITY IN RELATION TO HEAT ILLNESS SEVERITY AUTHOR(S)ROBERT F. WALLACE, Sc.D, M.P.H. Study 1. A case-crossover study was conducted in male and female Marine Corps recruits in basic tiaining at Marine Corps Recruit Depot (MCRD), Parris Island, SC to investigate the effects of alternative indices of heat exposure on exertional heat illness (EHI) risk. Weather measurements were obtained for 2,069 cases of EHI identified in this population during 1979-1997. As expected, the risk for developing EHI increased with increasing wet bulb globe temperature (WBGT), which is the standard heat index used by the Marine Corps. EHI risk was found to be associated not only with the WBGT at the time of the event, but by the previous day's average WBGT as well. This result suggests evidence of a cumulative effect of previous day's heat exposure in these Marine recruits at MCRD. Study 2. A matched case control study was conducted to investigate the effects of fitness and conditioning on EHI risk, as well as to compare the risk factors for mild and severe cases of EHI, as distinguished by core body temperature shortly after the event. Physical fitness, anthropomefric and physiological measurements were acquired for 660 EHI cases identified in this population for the period 1988-1996 and matched to 1,723 controls by initial training platoon. For severe cases, BMI and initial run-time did not have independent effects, but instead showed a less-than-additive effect at high levels of each. In contrast, BMI and run-time appeared to have independent effects on risk of mild EHI. FUNDING NUMBERS 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES)UStudy 3. A cohort mortality study was carried out among male and female U.S. Army personnel hospitalized for heat illness (HI) at U.S. Army hospitals during 1971-2000. Hospitalization records were obtained for 3,971 cases of HI and 17,233 referent cases of appendicitis (APX). Male and female HI cases had a 40% increased rate of all-cause mortality compared to APX cases. Further examining cause-specific deaths, male cases of HI were at increased risk of death from cardiovascular disease (CVD), ischemic heart disease (IHD), and heat related sites (CVD, liver [non-alcoho...

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Heat Stress

Adams¹

2001

Patty's Toxicology

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This chapter's goal is to provide useful, interesting, and up‐to‐date information about the way people respond to acute and chronic heat stress. It also presents some groundwork about biological control systems, how heat is produced and stored in the body, and how it is exchanged with the environment. This background is necessary to understand the many complex and interactive phenomena associated with heat stress and with the challenges of heat strain. It is important to recognize the uniqueness of heat as a form of energy to understand issues of heat stress and strain and to see its special role in human welfare. No other potentially endangering energy, for example, is produced by the body itself, none other is so essential for life, and none other is the thermodynamic destiny in entropy for all other forms of energy. No form of energy other than heat so directly affects life processes. Humans normally function in only a narrow range of deep body temperature. It is not always easy to spot the sources of heat danger or to gauge their effects. Heat‐induced disabilities come from net heat gain from the environment and also from that produced by metabolic activity, which alone can be crippling and lethal. Danger levels for most energy and molecular environmental stressors are predictable for everyone, but they are not for heat. It is not hard, for example, to define a “threshold limit value” and safe exposure levels for gamma and ultraviolet radiations, sound intensity, and exposures to concentrations of specific chemicals. A toxic level for one person is just about as endangering as it is for someone else. It is quite different for heat. The effects of heat stress must be seen in a different way. One level of environmental heat exposure and rate of heat production from work or exercise may be comfortably, safely and easily tolerated by one person, yet be uncomfortable, disabling, and potentially lethal for another, even though they work side by side at comparable tasks. Solving the complex problems of human thermal safety requires more than just measuring the intensity of contributing environmental factors. It requires additional analyses of a person's internal and external thermal environments and body heat distribution and also of many unique personal characteristics Situations that challenge human thermoregulation must be surveyed at two levels. One is a need to look at the conditions of heat stress, the other must evaluate the level of heat strain. Heat stress and strain are functionally related, of course, but one does not predict the other. Distinguishing between factors of heat stress and human heat strain is essential. It is naive, dangerous, and potentially lethal to consider that measuring only factors of heat stress, no matter how completely and precisely, or using one's own thermal comfort is any reliable gauge for another person's level of heat strain (10–12). Evaluating human heat strain is a complex but interesting detective story. Lessons learned are applicable to issues of the workplace, and they are also pertinent to each of us personally, to our family members, and to all life forms on the planet.

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Acute myocardial infarction in a young man after heat exhaustion

Cited by 23 publications

References 6 publications

A Case of Severe Heat Stroke With Abnormal Cardiac Findings

A Case of Severe Heat Stroke With Abnormal Cardiac Findings

Risk Factors and Mortality in Relation to Heat Illness Severity

Heat Stress

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