Cardiovascular and metabolic manifestations of heat stroke and severe heat exhaustion

Costrini, Anthony M.; Pitt, Henry A.; Gustafson, A.; Uddin, David E.

doi:10.1016/0002-9343(79)90548-5

Cited by 141 publications

(68 citation statements)

References 19 publications

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“…[7][8][9][10][11] In light of our results, we believe that although victims of heat stroke may have an appreciable total body fluid deficit, it seems that this is mainly at the expense of the intracellular compartment accounting for signs of dehydration while the intravascular compartment manages to keep an adequate circulating volume and avoids significant depletion. The low blood pressure in heat stroke, 12,13 in our experience, is due to low peripheral vascular resistance rather than to significant intravascular depletion or a low cardiac output.…”

Section: Discussionmentioning

confidence: 55%

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Hemodynamic Changes and Intravascular Hydration State in Heat Stroke

et al. 1989

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Acute and serial hemodynamic measurements in 13 pilgrims (average age, 55.2 ± SD 9.3 years) suffering from heat stroke (average rectal temperature, 41.3 ± 1.0°C) revealed a hyperdynamic circulation pattern and a low total peripheral resistance. Five patients had pulmonary edema with an average cardiac index of 5.29 ± SD 0.56 L/min/m 2 , which was slightly higher than the average cardiac index in the group of eight patients without pulmonary edema, 4.76 ± SD 0.6 L/min/m 2 . This higher cardiac index was believed to be due to iatrogenic fluid overload which was hard to accommodate intravascularly with the cooling process raising the peripheral vascular resistance, decreasing the venous capacitance, and redistributing the blood from the dilated circulatory bed in the skin to the central circulation. Our data highlight the fact that there is no major intravascular dehydration in heat stroke. The treatment of choice is cooling. The entire process of "supporting the cardiovascular system" should take into consideration avoidance of fluid overload by rapid intravenous fluid administration. Gradual hydration, allowing time for intracellular compartment repletion after cooling, is more appropriate.

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Section: Discussionmentioning

confidence: 55%

“…This may particularly help skin perfusion and heat exchange in cases of skin vasoconstriction, and it may also prove particularly helpful in cases of poor tissue perfusion and lactic acidosis. 13,14 …”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Changes and Intravascular Hydration State in Heat Stroke

et al. 1989

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“…5) On the other hand, Costrini, et al did not find elevated levels of the MB fraction of CK in any of their 13 heat stroke patients. 19) The difference may be attributable to the severity of exposure of the myocardium to a high temperature and/or the severity of myocardial ischemia. Our data showed extraordinarily high levels of these markers; a 580-fold increase for CK-MB and a 170-fold increase for troponin I above the upper normal.…”

Section: )mentioning

confidence: 99%

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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“…Contudo, pode ocorrer hipertermia excessiva na ausência de desidratação importante, principalmente em corridas de menos de 10km, já que o ritmo mais acelerado gera um maior calor metabólico 62 . As taxas de mortalidade e de lesão de órgãos devido ao colapso pelo calor são proporcionais à duração do período entre a elevação da temperatura central e o início da terapia de resfriamento 28,72 . Portanto, um diagnóstico rápido e um pronto início do resfriamento são essenciais 7,19,26,28,52,53,58,61,67 .…”

Section: Colapso Pelo Calor Induzido Pelo Exercíciounclassified

Distúrbios causados pelo frio e pelo calor durante corridas de longa distância

1999

Rev Bras Med Esporte

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Distúrbios causados pelo frio e pelo calor durante corridas de longa distância RESUMOMuitos corredores amadores e de elite participam todos os anos de corridas de longa distância. Quando estes eventos ocorrem em temperaturas altas ou baixas, aumenta o risco de distúrbios térmicos. Contudo, a hipertermia induzida pelo exercício, a hipotermia, a desidratação e outros problemas relacionados podem ser minimizados através de esclarecimentos e um preparo antes do evento. Este documento fornece recomendações para o diretor médico e outras autoridades da organização das corridas nas seguintes áreas: planejamento, profissionais envolvidos na organização, instalações, suprimentos, equipamento e comunicação; fornecimento de esclarecimentos aos participantes; avaliação do estresse térmico; fornecimento de líquidos; e prevenção de questões legais em potencial. Este posicionamento oficial também descreve as condições predisponentes, as formas de diagnóstico e o tratamento dos quatro distúrbios ambientais mais comuns: exaustão pelo calor, colapso pelo calor, hipotermia e congelamento de extremidades. Os objetivos deste documento são: 1) Educar os organizadores e os participantes de corridas de longa distância a respeito das formas mais comuns de distúrbios tér-micos incluindo as condições predisponentes, sinais de alerta, suscetibilidade e a redução de sua incidência; 2) Alertar os organizadores sobre as suas responsabilidades civis em potencial no que concerne à segurança do evento e à prevenção de lesões; 3) Recomendar que os organizadores consultem arquivos locais de meteorologia e planejem eventos em horas que provavelmente causem menos estresse térmico de modo a minimizar os efeitos deletérios sobre os participantes; 4) Estimular os organizadores a alertar os participantes sobre o estresse térmico no dia da corrida e as suas implicações no que tange aos distúrbios causados pelo frio e pelo calor; 5) Informar os organizadores sobre as ações preventivas que podem reduzir a incidência dos distúrbios ligados ao frio e ao calor; Traduzido, com permissão por escrito, do original: American College of Sports Medicine. Position Stand on heat and cold illnesses during distance running. Med Sci Sports Exerc 1996;28(12):i-x. 6) Descrever o pessoal, o equipamento e o material necessá-rios para reduzir a incidência e tratar casos de colapso e distúrbios térmicos. INTRODUÇÃO Este documento substitui o posicionamento oficial intitulado Prevenção de distúrbios térmicos durante corridas de longa distância1 , considerando os problemas que podem afetar a grande comunidade de corredores amadores e atletas de elite que participam de corridas de longa distância. Este texto foi ampliado de modo a incluir a exaustão pelo calor, o colapso pelo calor, a hipotermia e o congelamento de extremidadesos distúrbios ambientais mais comuns durante as corridas.Devido ao fato de que as respostas fisiológicas ao exercício em ambientes desfavoráveis podem variar entre os participantes e também de que o estado de saúde dos participantes pode variar de um dia pa...

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Cardiovascular and metabolic manifestations of heat stroke and severe heat exhaustion

Cited by 141 publications

References 19 publications

Hemodynamic Changes and Intravascular Hydration State in Heat Stroke

Hemodynamic Changes and Intravascular Hydration State in Heat Stroke

A Case of Severe Heat Stroke With Abnormal Cardiac Findings

Distúrbios causados pelo frio e pelo calor durante corridas de longa distância

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