A Case of Heat Exhaustion Masquerading as ST-Elevation Myocardial Infarction

Heat-related illnesses (HRIs) are characterized by hyperthermia, neurological dysfunction, and multiorgan damage. Cardiac dysfunction has been reported, but ST-elevation with a rise in cardiac markers suggesting acute coronary syndrome has been infrequently reported. Data from the middle east in particular is lacking. This is a case of a 43-year-old male patient from the United Arab Emirates diagnosed with acute inferior ST-elevation myocardial infarction necessitating cath lab activation revealing normal coronary arteries. Echocardiography did not show evidence of wall motion abnormalities. After reviewing his clinical presentation, he was diagnosed with heat exhaustion complicated by rhabdomyolysis and acute kidney injury. The patient fully recovered with intensive medical care. This case showed that the electrocardiographic changes and elevation of cardiac markers do not reflect true cardiac ischemia but rather a pathophysiological response to HRI. Previously published reports were scarce and showed conflicting results due to the heterogenicity of cases and methods as well as the lack of angiographic documentation of coronary pathology. This case report demonstrates the importance of early recognition and timely management of HRI cases with an unusual presentation that mimics myocardial infarction, especially in countries with high ambient temperatures during the summer seasons.