International Journal of Cardiology 47 (1995) 297-300 Acute myocardial infarction in a young man after heat exhaustion Juan C. Garcia-Rubira*, Javier Aguilar, Dolores Romero Unidad Coronaria, Hospital Virgen Macarena. Avenida Dr Fedriani, 3, 41009 Seville, Spain Received 9 August 1994; revision accepted 27 September 1994 Abstract A 33-year-old man with heat exhaustion was admitted to our hospital suffering from severe chest pain. Serum creatine kinase elevation and new Q waves revealed myocardial infarction of the inferior wall. Technetium-99m- pyrophosphate suggested diffuse myocardial damage, although the left ventricular function was normal by echocar- diography. This case highlights the importance of early recognition of heat stroke and heat exhaustion, as they are associated with widespread tissue injury. Keywords: Acute myocardial infarction; Heat exhaustion; Heat stroke 1. Introduction Heat stroke is an acute thermoregulatory failure that results from exposure to high temperatures [l]. The diagnosis is usually based on central ner- vous system dysfunction and rectal temperature of 41°C or higher [ 1,2]. Heat exhaustion is a related syndrome whose diagnosis does not require hyper- pirexia and alteration of the mental status, but inability to continue exertion unaided [3]. We pre- sent a case of myocardial infarction after heat ex- haustion. 2. Case report A 33-year-old man started to suffer from diz- * Corresponding author, ziness, leg cramps, weakness and intense sweating while he was working by harvesting peaches. He was exposed to the very high temperatures of July in Seville (> 40°C) and the physical activities had been very vigorous. He did not come to the hospi- tal until several hours later, when he noted op- pressive chest pain radiated down the left arm, nausea and vomiting. On admission his tempera- ture was 39°C heart rate 100, and blood pressure 120/80. His mental status was normal, and the physical examination was otherwise unremark- able. He was transferred to a cold environment and an intravenous solution of normal saline with 5% dextrose was begun. The first electrocardio- gram showed diffuse ST-segment elevation sug- gestive of acute pericarditis (Fig. la); an anti- inflamatory (diclophenac) was administered. Serial electrocardiographic changes revealed a 0167-5273/95/.$09.50 0 1995 Elsevier Science Ireland Ltd. All rights reserved SSDI 0167-5273(94)02204-V