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Non-invasive evaluation of cardiac abnormalities in heat stroke pilgrims
S S al-Harthi1, M S Nouh, H al-Arfaj
1Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Insights
Acute heat stroke significantly impacts cardiac function, causing abnormalities like arrhythmias and wall motion issues. These findings highlight the critical cardiovascular risks associated with heat illness.
Area of Science:
- Cardiology
- Environmental Medicine
- Critical Care Medicine
Background:
- Heat stroke is a severe hyperpyretic condition with significant morbidity and mortality.
- Cardiovascular complications are common in heat stroke patients, but their spectrum and frequency require further elucidation.
Purpose of the Study:
- To investigate the cardiac manifestations of acute heat stroke using electrocardiography (ECG) and echocardiography.
- To assess the prevalence of cardiac abnormalities in pilgrims experiencing heat stroke.
Main Methods:
- Serial ECGs and echocardiograms were performed on 51 acute heat stroke patients immediately after cooling and 24 hours later.
- Cardiac findings were compared to a control group of 43 patients.
Main Results:
- Echocardiography revealed regional wall motion abnormalities (17.6%), pericardial effusion (25%), and asymmetrical septal hypertrophy (15.6%).
- ECG showed sinus tachycardia (78%), atrial fibrillation (15.7%), and sinus bradycardia (5.8%). Ischemic changes (ST depression) were noted in 9 cases.
- 13 patients (25.5%) had normal echocardiographic findings.
Conclusions:
- Heat stroke induces multifactorial adverse cardiac effects, including arrhythmias and structural changes.
- Cardiac status is a crucial indicator of overall cardiovascular health in heat stroke patients.
- Prompt cardiac evaluation is essential for managing heat stroke patients effectively.
Abstract:
Serial electrocardiograms as well as echocardiographic studies of 51 pilgrims suffering from acute heat stroke (mean rectal temperature 41.6 degrees C) were performed. All patients were examined immediately after cooling and 24 h later whenever possible. Regional wall motion abnormalities were detected in 9 cases (17.6%) while pericardial effusion was observed in 13 cases (25%) and asymmetrical septal hypertrophy was detected in 8 cases (15.6%). Other cardiac abnormalities included right ventricular dilatation and increased in left ventricular internal dimensions in 4 cases (7.8%), respectively. Thirteen cases (25.5%) had normal echocardiographic findings. Forty (78%) patients had sinus tachycardia while 8 cases (15.7%) showed atrial fibrillation with uncontrolled ventricular rate, and 3 (5.8%) had sinus bradycardia. Heat stroke electrocardiograms showed tracings demonstrating ST segment depression, compatible with ischaemia in 9 cases, while in 6 cases there were nonspecific T wave changes, whereas in another 4 cases the tracings demonstrated different conduction abnormalities. The collected data were analysed and compared to those of 43 control patients. The adverse effects of heat stroke on the heart are multifactorial requiring the utmost attention and understanding, as they reflect the patient's cardiovascular status.