The pathopysiology of heat stroke: an integrative view of the final common pathway

Abstract

Heat stroke is defined as a condition in which body temperature is elevated to such a level that it becomes a noxious agent causing body tissue dysfunction and damage with a characteristic multi-organ clinical and pathological syndrome. Marked hyperthermia, usually above 40.5°C and associated encephalopathy, occurs after thermoregulation is subordinated to circulatory and metabolic demands and to the associated systemic inflammatory reaction. Exertional heat stroke is a function of both intrinsic and extrinsic modulators. Intrinsic modulators like genetics, fitness, acclimatization, illness, medications, and sleep quality can alter individual risk and outcomes, while extrinsic modulators like exercise intensity and duration, clothing and equipment, ambient temperature, relative humidity, and solar radiation can affect the group risk and outcomes. This review integrates the current theoretical and accepted knowledge of physiological alterations into one model that depicts a common pathway from heat stress to heat stroke.

Short-term, low-volume training improves heat acclimatization in an operational context

“…Rectal temperatures at rest and during exercise were not additionally improved by training. This may indicate that physical exercise during this short heat acclimatization period did not confer better protection against exertional heat stroke, as uncompensable hyperthermia is responsible for neurological disorders and multi-organ breakdown (Epstein and Roberts, 2011). However, improvement in cardiac stability and the larger NaCl reabsorption observed in the T group theoretically confers a better protection against other heat illnesses such as heat exhaustion and syncope (Yamazaki, 2013).…”

Initial Chest Radiographic Findings in Heatstroke Patients

“…The respiratory system may be involved with heat stroke in various ways (1)(2)(3). To the best of our knowledge, the literature describing the initial chest radiographic imaging features of patients with heat stroke is sparse (1)(2)(3)(4)(5)(6)(7). In this study, we aimed to evaluate the initial chest radiographic findings in a group of heatstroke patients referred to our care as a result of the September 2015 Mecca stampede(8).…”

“…exertional type) or in the absence of it (i.e. classic type) (1). The primary system affected by heatstroke is that of the central nervous system, but multisystem involvement is common as well (1,2).…”

“…classic type) (1). The primary system affected by heatstroke is that of the central nervous system, but multisystem involvement is common as well (1,2). The respiratory system may be involved with heat stroke in various ways (1)(2)(3).…”

“…The primary system affected by heatstroke is that of the central nervous system, but multisystem involvement is common as well (1,2). The respiratory system may be involved with heat stroke in various ways (1)(2)(3). To the best of our knowledge, the literature describing the initial chest radiographic imaging features of patients with heat stroke is sparse (1)(2)(3)(4)(5)(6)(7).…”