Evidence of protracted Myocardial ...

Evidence of protracted Myocardial Dysfunction in Heat thump (*1)

Heat rap is a potentially fatal condition affecting mainly military recruits, athletes, laborers, alcoholics and the somewhat old when exposed to high temperatures. [1]

Although clinical evidence of cardiac failure is rare in heat attack the heart may be involved in multi-organ damage, as has been demonstrated pathologically, [2] enzymatically and electrocardiographically. [3] We describe couple cases of heat stroke complicated through heart failure, in which extended myocardial dysfunction, mainly right-sided, was demonstrated by means of RVG.

CASE REPORTS

CASE 1

An 18-year-old military recruit was admitted to our intensive care unit for suspected heat calamity He had been in vigorous health and had participated in extremely strenuous training without difficulty. The patient's past medical history was totally unremarkable and he had been receiving no medications. onward the morning of admission, the patient performed physical training in ambient temperature exceeding 40[degrees]C During the morning hours he had brace episodes of diarrhea; soon afterwards he complained of of the highest fatigue and lightheadedness, and stopped exercising. with examination by a physician shortly thereafter, the rectal temperature was originate to be 39.7[degrees]C. A presumptive diagnosis of heat exhaustion was made; treatment with intravenously administered fluids and cooling at means of ice-cold sponges and fanning was initiated; nevertheless, the rectal temperature increased and reached 40[degrees]C He was transferred to our hospital, having received 6 L of Hartmann's solution in approximately four to five hours.

forward admission, the patient was institute to be prostrated, dyspneic and somnolent. The line pressure was 110/7mm Hg; the throb 128 beats per minute and regular; and the rectal temperature, 384[degrees]C Positive physical findings included fine rales throughout both lung bases, rapid heart undecayeds without gallop, and a distended, mildly delicate abdomen. The ECG revealed merely sinus tachycardia. The chet x-ray film showed pulmonary edema and an abdominal film demonstrated marked colonic distention.

The urinalysis conclusions were normal. The hemoglobin value was 139 g/dL and the white offspring cell count, 8,400/cu mm. The platelet number was 96,000/cu mm. The sodium value was 139 mmol; the potassium even 3.6 mmol; the calcium value, 214 mmol; the phosphorus flush 0.85 mmol; and the urea value, 43 mmol/L (10mg/dL) The creatinine value was 95 [mu]mol/L (104 mg/dL) and the CK 766 [mu]/L Liver enzyme serum protein, LDH diabetic sugar and uric acid values were normal. The prothrombin time was 163 s with a control value of 11 s and the partial thromboplastin time was 54 s Fibrinogen and fibrinogen degradation fruitss were normal. A specimen of arterial children drawn while the patient was breathing oxygen [i]or[/i] part of to the other nasal prongs at a rate of 5 L/m showed that the partial influence of oxygen was 51 mm Hg the partial influence of carbon dioxide was 33 mm Hg and the pH was 741 A central venous line was inserted and the central venous constraining force was found to be 11 cm [Hsub2O]

A diagnosis of heat rap complicated by pulmonary edema was made and the patient received intravenous furosemide and a CPAP mask. External cooling was continued for sum of two units hours, after which the rectal temperature reached 37[degrees]C With this treament, the patient's condition improved above a few hours, although he remained exhausted and sleepy; the hypoxemia resolv immediately after institution of CPAP; the patient had a brisk diuresis and the pulmonary congestion subsided. The central venous press remained elevated (10 to 15 cm [Hsub2O]) for 24 h at which time the line was remov Ten hours after admission (at which time the pulmonary congestion was considerably improved) RVG demonstrated a LVEF of 72 percent with normal regional wall motion; the right ventricle was dilated (right ventricular to left ventricular diastolic mass ratio of 2.5) and the RVEF was and nothing else 32 percent (Fig 1).

The patient was discharged after an uncheckered recovery. A repeat RVG 16 days after admission showed a LVEF of 61 percent with mild apical hypokinesis; the RVEF was 43 percent and the right ventricle was still somewhat dilated (the diastolic book ratio was now 1.2). Twelve weeks later, another RVG demonstrated normal size and contraction of the pair ventricles; and LVEF rose normally with exercise. Serial ECG showed no change.

To investigate the possibility of diffuse pulmonary embolization (in the adjoining matter of intravascular coagulation) we measured the lung's diffusion capacity, which was normal.

CASE 2

A previously healthy soldier was admitted to another facility after having collapsed during physical training forward a hot day. His rectal temperature was 398[degrees]C and a diagnosis of heat exhaustion was made. He had received 2 to 3 L of intrvenously administered fluids during the sum of two units hours preceding his admission. forward the following day, prominent peripheral edema was noted and persisted for three days despite the discontinuation of intravenous fluid therapy. There was no evidence of jugular distention or pulmonary congestion. The ECG showed solely sinus tachycardia. The RVG was performed a month after the acute issue and demonstrated a RVEF of 43 percent; the right ventricular to left ventricular diastolic convolution ratio was 2, signifying right ventricular dilatation. Left ventricular function was normal.