Mechanisms and Intervention Strategies for Heat Stroke-Associated Myocardial Dysfunction: A Narrative Review

Heatstroke is a life-threatening condition defined by a core body temperature exceeding 40° C and central nervous system dysfunction. Its onset is potentiated by high heat and humidity, especially if superimposed upon high thermal loads due to exertion or to impaired ability to sweat as associated with the use of certain medications. The condition can trigger systemic inflammation and potentially fatal multi-organ failure. The heart is a primary organ affected; heatstroke-associated myocardial dysfunction may present as tachycardia, arrhythmias, heart failure, or ischemic injury.

This narrative review was informed by a structured search of PubMed and Embase. The search focused on literature from the past 10 years, supplemented by earlier seminal studies where necessary. Key search terms included heatstroke, myocardial injury, dysfunction, biomarkers, cooling strategies, monitoring, and circulatory support. We prioritized human clinical studies, reviews, and consensus statements on acute management, along with preclinical studies.

Heatstroke-associated myocardial dysfunction has a multifactorial pathophysiology involving direct thermal cytotoxicity, systemic inflammation, endothelial injury, coagulopathy, mitochondrial dysfunction, and dysregulated cell death. Cardiac manifestations include myocardial injury, arrhythmia, and ventricular dysfunction. Early diagnosis requires an electrocardiogram, cardiac biomarkers, and echocardiography. Management is centered on rapid cooling, hemodynamic support, and close monitoring. Refractory cases may require invasive temperature control or mechanical circulatory support.

Heatstroke-associated myocardial dysfunction is a clinically important and potentially reversible complication. Timely cooling, vigilant cardiovascular assessment, and supportive management remain central to care, while targeted therapies and refined risk-stratification strategies require further clinical investigation.