Nzvere Farirai P, Tariq Ezza, Nishanth Katukuri, Arshid Assam, Cancarevic Ivan
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2020 Aug 6;12(8):e9595. doi: 10.7759/cureus.9595.
Heatstroke, defined as an elevated core body temperature above 40°C accompanied by altered mental status (e.g., confusion, disorientation, seizure and coma), is the most severe and life-threatening condition in the spectrum of heat-related illnesses. Heatstroke patients may present with multi-organ dysfunction, but with rapid cooling and organ failure management, a full recovery often occurs within weeks. Long-term impairment is rare, with neurological impairment occurring most frequently. Despite an abundance of research on the persistent neurological and hepatic impairments, our knowledge of the long-term cardiovascular events in patients with heatstroke history is poor. We wondered whether heatstroke leads to cardiovascular diseases long after full recovery. Using Pubmed, Web of Science and Scopus, we gathered cohort studies looking at cardiovascular disease incidence or mortality as an outcome, including heatstroke animal studies. Based on the available literature, we found that a history of heatstroke is associated with an increased risk of cardiovascular diseases, including ischemic heart disease, heart failure and atrial fibrillation. Delayed metabolic disturbances occurring in exertional heatstroke mice are linked to the formation of atherosclerosis and the development of heart failure. These processes provide potential pathophysiological pathways leading to ischemic heart disease and heart failure in heatstroke patients. Our findings may massively impact our understanding of heatstroke recovery and the follow up of heatstroke patients. Therefore larger, more adequately powered cohort studies with cardiovascular disease as an outcome, in tandem with animal studies examining the underlying pathophysiology, are required to confirm or reject these findings and answer the proposed questions.
中暑被定义为核心体温升高至40°C以上并伴有精神状态改变（如意识模糊、定向障碍、癫痫发作和昏迷），是热相关疾病中最严重且危及生命的状况。中暑患者可能会出现多器官功能障碍，但通过快速降温及器官衰竭管理，通常在数周内即可完全康复。长期损伤较为罕见，其中神经功能障碍最为常见。尽管对持续性神经和肝脏损伤已有大量研究，但我们对有中暑病史患者的长期心血管事件了解甚少。我们想知道中暑在完全康复很久之后是否会导致心血管疾病。通过使用PubMed、科学网和Scopus，我们收集了以心血管疾病发病率或死亡率为结果的队列研究，包括中暑动物研究。基于现有文献，我们发现中暑病史与心血管疾病风险增加有关，包括缺血性心脏病、心力衰竭和心房颤动。劳力性中暑小鼠中出现的延迟性代谢紊乱与动脉粥样硬化的形成及心力衰竭的发展有关。这些过程为中暑患者导致缺血性心脏病和心力衰竭提供了潜在的病理生理途径。我们的研究结果可能会极大地影响我们对中暑康复及中暑患者随访的理解。因此，需要开展更大规模、更有充分说服力的以心血管疾病为结果的队列研究，并结合研究潜在病理生理学的动物研究，以证实或反驳这些发现并回答所提出的问题。
