Acute Myocardial Infarction Induced by Alternating Exposure to Heat in a Sauna and Rapid Cooling in Cold Water

Abstract

We describe a patient with acute myocardial infarction, which was thought to result from plaque rupture or thrombosis because of coronary artery spasm. The vasospasm was most likely induced by stimulation of the α-adrenergic receptors during alternating heat exposure during sauna bathing and rapid cooling during cold water bathing. This report emphasizes the dangers of rapid cooling after sauna bathing in patients with coronary risk factors.

Myocardial ischemia caused by cold-water submersion

“…Cardiac or cerebrovascular causes, secondary to haemoconcentration and subsequent thrombus formation, or malignant arrhythmias after sympathetic activation have been implicated [6]. Myocardial ischemia secondary to coronary artery spasm or to significant increases in coronary vascular resistance may occur in subjects with atherosclerotic coronary arteries [3][4][5]. Our report indicates that cold-water submersion can cause myocardial ischemia also in subjects with normal coronary vessels.…”

“…Although the reflex increase in coronary vascular resistance after cold-water exposure has long been recognized in patients with coronary artery disease [3,4], little is known on vasomotor changes, in response to cold stimuli, in patients with normal coronary arteries. Imai et al [5] reported a case of acute myocardial infarction, induced by alternating exposure to heat in a sauna and rapid cooling in cold water, in a patient with atherosclerotic coronary arteries. However, to our knowledge, no cases of myocardial injury, secondary to cold-water submersion, have been reported in subjects with normal coronary arteries.…”

Sauna Stroke Syndrome

“…These acute changes are responsible for hazards such as cardiac arrhythmia, sudden heart death, or myocardial vasospasm leading to infarction. 3,4 Recently, a patient was reported who had a saunarelated stroke. Hypotension and dehydration during sauna combined with pre-existing internal carotid artery stenosis were considered as pathophysiologic factors of this stroke.…”

“…However, there are a number of reports of adverse, in particular, cardiac events. [1][2][3][4][5] We report a case of acute large cerebral infarction during sauna bathing in a patient without typical cerebrovascular risk factors, and propose the term "sauna stroke syndrome" for this clinical condition.…”

A cold shock response triggering acute myocardial infarction

“…It has already been reported that sudden submersion in cold water may provoke myocardial infarction in both subjects with atherosclerotic coronary disease and young people with angiographically normal coronary arteries [4,5]. The stimulation of cutaneous cold receptors initiates a sympathetic system mediated cardiovascular response termed "the cold shock" response which includes tachycardia and rise in blood pressure; it is also known that the activation of the alpha adrenergic receptors may induce coronary vasospasm [6,7], thereby causing myocardial ischemia [8].…”