Article Text

Download PDFPDF
Effects of heat stroke on surface ECG: a study on clinical outcomes
  1. Amal Paul1,
  2. Reginald Alex2,
  3. John Roshan Jacob1,
  4. Bijesh Yadav3
  1. 1Cardiology and cardiac electrophysiology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
  2. 2Accident and Emergency, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
  3. 3Biostatistics, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
  1. Correspondence to Professor John Roshan Jacob, Cardiology, Christian Medical College and Hospital Vellore, Vellore 632004, Tamil Nadu, India; johnroshanjacob{at}gmail.com

Abstract

Aims Classic heat stroke is associated with high in-hospital mortality and morbidity. The relation between the ECG findings in heat stroke and the clinical outcomes of these patients has not been studied. The aim of this study was to describe the electrocardiographic features in patients with classic heat stroke and to determine if there is any correlation of ECG findings with in-hospital outcomes.

Methods We performed a retrospective study on 50 patients with classic heat stroke during summer months of 2016–2018. All 12-lead electrocardiographic recordings obtained from these patients were subjected to in-depth analysis. Statistical analysis was done to determine the correlation of electrocardiographic findings with in-hospital outcomes.

Results 37 patients were in sinus rhythm, while supraventricular arrhythmias including atrial fibrillation (n=6), ectopic atrial tachycardia (n=4) and atrial flutter (n=2) were observed in the rest. There was a high prevalence of QTc prolongation, low voltage P waves, conduction defects like incomplete right bundle branch block and repolarisation abnormalities. The ratio of QRS voltage in the limb leads to that in precordial leads was ≤0.5 in nearly three-fourths of the patients. Among the observed electrocardiographic features, low P-wave voltage (<0.01 mV) in lead II was found to have statistically significant correlation with adverse in-hospital outcome (OR 8.93, p=0.04), after adjustment for clinical covariates.

Conclusion There was high incidence of atrial arrhythmias in patients with classic heat stroke. A low P-wave voltage (<0.01 mV) in lead II was predictive of adverse in-hospital outcome in this cohort of patients.

  • classic heat stroke
  • hyperthermia
  • heart
  • electrocardiography
  • atrial arrhythmias
View Full Text

Statistics from Altmetric.com

Footnotes

  • Contributors AP was involved in the conceptualisation; data curation; formal analysis; investigation; methodology; roles/writing—original draft; writing—review and editing. RA was involved in the investigation; methodology; writing—review and editing. JRJ was involved in the data curation; formal analysis; investigation; methodology; roles/writing—original draft; writing—review and editing. BY was involved in the statistical analysis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the institutional review board and ethics committee of Christian Medical College Vellore, Tamil Nadu, India.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.