Heat stroke can be fatal in vulnerable people

Most of us celebrate the summer, not least because we associate it with the well-deserved holiday break. “Summer” is thinking about the beach, enjoyment, and relaxation, but you also have to be on your guard in the face of these high temperatures.

Elevated ambient temperature can be an important mechanism for increasing body temperature.

Most heat-related illnesses (except rashes and cramps) are a more or less severe consequence of a failure in the body’s thermoregulation system.

The leading causes of mortality during heat waves are related to cardiovascular, cerebrovascular, and respiratory diseases. The reason? With high temperatures, the possibility of dehydration increases, accentuating cardiovascular risk in those who are more prone to circulatory or arterial problems. With a lot of heat, alterations in the thermoregulation mechanism are more likely, which attempts to reduce body temperature through sweating and dilation of peripheral blood vessels. This, in turn, can also increase dehydration states and drastically decrease blood pressure to produce dizziness and, in extreme cases, syncopation or heat stroke.

Symptoms of dehydration usually begin with a feeling of tiredness, mild dizziness, low blood pressure, or tachycardia, followed by muscle contractures or cramps. Seizures or total loss of consciousness may even occur.

It is proposed that coronary and cerebral thrombosis seems to be related to the loss of water and salt in a hot environment, which results in a higher concentration of blood and a thrombogenic increase in the viscosity of platelets and red blood cells.

We must emphasize hypertensive patients, which in our country represent 31%, according to the 2017 survey of the Dominican Society of Cardiology in people over 18 years of age, who are also vulnerable, since the present heatwave and intense physical exercise can alter the hypertensive response of patients. Therefore, in this group of patients, we must control the intensity of exercise.

The population groups considered to be those at greatest risk of suffering the harmful effects on health from heat are as follows:

1st: People over 65 years of age, especially the very elderly and those dependent on another person for basic care of living, usually have difficulty mobilizing or are bedridden.

2d: Individuals with Cardiovascular Diseases, Diabetes Mellitus, Chronic Obstructive Pulmonary Disease, Renal Failure, Alzheimer’s Disease, Parkison and Psychiatric Diseases.

3rd: People taking certain medication such as:

• Antidepressants.

• Neuroleptics.

• Antihistamines.

• Diuretics.

• Beta-blockers.

• Vasodilators.

• Significant alcohol consumption.

4th: Individuals in situations such as:

• older adults living alone.

• People at risk who live alone or in poorly equipped housing.

• Excess weight or excessively low weight.

• Workers, athletes, or people who spend several hours outdoors in very hot environments, especially if they undergo significant physical exertion.

5th: Children under four years of age, especially children under one year of age.

6th:

• People who have suffered from pathology or diseases derived from heat.

• Emphasize the adults since the elderly have decreased the sensation of heat. Therefore, the ability to protect themselves and the thermolysis of the elderly is reduced, especially in neurodegenerative and diabetic patients.

• When an older adult has physical dependence, it is difficult for them to change their clothes and adapt to the environment.

Preventive measures for risky or exposed groups.
1st. Correct the housing environment, social, work, as well as lifestyle.

2d. Take into account personal and medication conditions.

3rd. Review the individual’s typical or extraordinary situations when exposed to very intense heat, such as working in very hot environments or traveling to very hot places.

4th. Identification of medication or self-medication (a usual treatment should not be discontinued).

5th. Evaluate the water intake (liquids) and the state of dehydration.

6to. Identify early to be able to take the necessary measures in case of a pathology related to heat.

Finally, athletes are recommended to exercise in cool weather with light clothing, drink enough fluids, and avoid extreme exercises in hot weather, especially if they are people with pre-existing diseases.

The author is an advisory cardiologist at the Dominican Institute of Cardiology Association.