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HEALTH PRESENTATION

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Beyond the burn

CARDIAC ARREST DUE TO EXERCISE INDUCED MALIGNANT HYPERTHERMIA

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Introduction and Understanding

Pathophysiology

Symptoms, Diagnosis, Treatment

Cardiac Arrest

Case Studies and Prevention Strategies

By the end of this presentation you will :

Understand

The term malignant hyperpyrexia, its relationship with exercise and the pathophysiology of cardiac arrest in relation

Recall

The symptoms, warning signs, diagnosis and treatment of this condition

Discuss

Relevant case studies and prevention strategies including education

Feel more confident

In having a general understanding of malignant hyperpyrexia, cardiac arrest and the link with exercise .

Introduction

Understanding malignant hyperthermia

Common Exercise Induced Complications

MSK INJURIES

Sprains, fractures, dislocations, joint, ligament, tendon issues
E.g. sprained ankle, fractured radius, dislocated glenohumeral joint, torn ACL, patellar tendonitis

Fatigue

Fainting, tiredness, heat exhaustion

Rhabdomyolysis
Bleeding and ecchymosis
Spontaneous subarachnoid haematoma
Airway blockage
Exercise induced medial conditions

Asthma, chest pain

Psychological complications

Overexercising, body image issues, mental health and self esteem issues to competitive sport

What is Malignant Hyperthermia?

Malignant hyperthermia is a severe reaction to certain drugs used for anesthesia. This severe reaction typically includes a dangerously high body temperature, rigid muscles or spasms, a rapid heart rate, and other symptoms

The link between exercise and malignant hyperthermia

Parallels

Malignant Hyperthermia

Exercise

A high amount of exercise and stress on the body can lead to the same symptoms and it can be a very rare complication of excessive exercise in young men

Malignant hyperthermia is often associated with a genetic trait that leads to increased bodily temperatures after the inhalation of certain anaesthetic agents

There are many parallels between exercise induced malignant hyperthermia and exercise induced heat illness

Pathophysiology

Mechanism of Malignant Hyperthermia

Muscles

Membrane

The muscles membrane integrity is compromised

Biochemical processes set off by calcium imbalance

Muscles are activated in a hyper metabolic state

This leads to hyperkalaemia and rhadbomyolysis

Releases an uncontrolled amount of mycoplasmic calcium

This leads to ATP depletion

Abnormal ryanodine receptor in Sarcoplasmic reticulum in skeletal muscle

Muscles are activated so respiration is required

Calcium

ATP

Symptoms and warning signs

Warning signs and risk factors

Lack of acclimatisation and dehydration

Family and personal medical History

Medical conditons

Skin conditons e.g. psoriasis, pheochromocytoma, hyperthyroidism Medications such as cocaine and Anticholinergics

If you or relatives have experienced symptoms of malignant hyperthermia due to anaesthetics, rhabdomyolysis or heat illnesses

Rhabdomyolysis

Inc. EtCO2Tachypnoea

RAT Rigidity Acidosis Temperature (high)

DIC MODS

Rhabdomyolysis

Diagnosis

Treatment

Symptoms and causes

Intense muscle pain, dark brown or red urine Casues can be due to starvation, over exercise, trauma and seizures

Sodium bicarbonate IV fluids Mannitol Rest

Symptomatic diagnosis along with elevated CK .

Diagnosis

Clinical Signs

Hypercapnia
Tachycardia
Muscle rigidity
Rhabdomyolysis
Hyperthermia
Arrhythmia

Tests
Respiratory and metabolic acidosis
Hyperkalaemia
Increased EtCO2
Elevated creatine kinase
Serum and urine myoglobin

treatment

Treatment

STOP

Stop the exercise that is leading to the issue and the cause of the malignant hyperthermia

Heat control

Cool the patient down, remove them from a hot atmosphere, remove clothes and use cool IV fluids

Electrolytes

Try to optimise the electrolytes of the patient

Dantrolene

Dantrolene is a drug that can be given in malignant hyperthermia

Other Medications for Treatment

The medications given for treatment, during cardiac arrest include

Dantrolene
Calcium chloride
Insulin and glucose
Sodium bicarbonate

Mannitol can be given for rhabdomyolysis and cooled IV fluids for hyperpyrexia

Calcium Chloride and insulin and glucose for hyperkalaemia

Sodium bicarbonate

Clinical signs detected

Symptom Initiation

Exercise

HyperK

Rhabdomyolysis

Cardiac Arrhythmias

Coma

DIC

Death

SIRS / MODS

cardiac arrest

Cardiac arrest

Cardio respiratory changes

Rhabdomyolysis

Hyperthermia

muscle breakdown

Hypovolaemia

Hypoxia

SIRS

NA

ACIDOSIS

Increased arrhythmogenecity of cardiac sodium channels

Changes in breathing, increased EtCO2 is a common sign that is not found in normal CA, ROSC and can differentiate from Isolated hyperkalemiac arrest

Excess sweating

Altered cardiac contractility

SIRS like / sepsis like conditions caused by hyperthermia This can also lead to DIC and thrombosis

Severe hyperkalaemia

case studies

Temperature and acidosis (listed later)

No other members suffered

Stumbling and disoriented

Rigidity

How could his chances of survival been improved?

Treatment

ALS

K+

Use CaCl to protect the heart and consider an insulin and glucose

Follow the ALS algorithm in cardiac arrest

Dantrolene

CO2

ROSC

Cooling

Try and reach normocapnia by including hyperventilation

Once ROSC is achieved monitor for 48-72 hours and contact a specialist

ERC Guidelines

RATS IN THE SHED

R - Rhabdomyolysis / rigidity A- acidosis T - temperature (high) S - stop the triggering agent H - hyperventilation (and oxygen) / heat control E - electrolyte imbalances (correct and correct acidosis) D - dantrolene

MENTIMETER CODE 22455927

Mayo Clinic. (n.d.). Malignant hyperthermia-Malignant hyperthermia - Symptoms & causes. [online] Available at: https://www.mayoclinic.org/diseases-conditions/malignant-hyperthermia/symptoms-causes/syc-20353750#Rosenberg, H., Sambuughin, N., Riazi, S. and Dirksen, R. (1993). Malignant Hyperthermia Susceptibility. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK1146/ www.uptodate.com. (n.d.). UpToDate. [online] Available at: https://www.uptodate.com/contents/malignant-hyperthermia-diagnosis-and-management-of-acute-crisis#:~:text=The%20diagnosis%20is%20based%20upon. ‌. ‌ Malignant Hyperthermia: Background, Pathophysiology, Etiology. (2021). eMedicine. [online] Available at: https://emedicine.medscape.com/article/2231150-overview?form=fpf [Accessed 27 Jan. 2024 Australia, H. (2021). Rhabdomyolysis. [online] www.healthdirect.gov.au. Available at: https://www.healthdirect.gov.au/rhabdomyolysis. ‌ www.nhlbi.nih.gov. (2022). Cardiac Arrest - Causes and Risk Factors | NHLBI, NIH. [online] Available at: https://www.nhlbi.nih.gov/health/cardiac-arrest/causes#:~:text=Some%20types%20of%20cardiomyopathy%2C%20and [Accessed 27 Jan. 2024]. Eijsvogels, T.M.H., Thompson, P.D. and Franklin, B.A. (2018). The ‘Extreme Exercise Hypothesis’: Recent Findings and Cardiovascular Health Implications. Current Treatment Options in Cardiovascular Medicine, [online] 20(10). doi:https://doi.org/10.1007/s11936-018-0674-3. ‌‌. Sports-Related Sudden Cardiac Arrest Is Rare in Older Adults. (n.d.). Sports-Related Sudden Cardiac Arrest Is Rare in Older Adults. [online] Available at: https://www.cedars-sinai.org/newsroom/research-alert-sports-related-sudden-cardiac-arrest-is-rare-in-older-adults/ [Accessed 27 Jan. 2024] www.nhlbi.nih.gov. (2022). Cardiac Arrest - Causes and Risk Factors | NHLBI, NIH. [online] Available at: https://www.nhlbi.nih.gov/health/cardiac-arrest/causes#:~:text=Some%20types%20of%20cardiomyopathy%2C%20and [Accessed 27 Jan. 2024]. ‌. Hosokawa, Y., Casa, D.J., Rosenberg, H., Capacchione, J.F., Sagui, E., Riazi, S., Belval, L.N., Deuster, P.A., Jardine, J.F., Kavouras, S.A., Lee, E.C., Miller, K.C., Muldoon, S.M., O’Connor, F.G., Sailor, S.R., Sambuughin, N., Stearns, R.L., Adams, W.M., Huggins, R.A. and Vandermark, L.W. (2017). Round Table on Malignant Hyperthermia in Physically Active Populations: Meeting Proceedings. Journal of Athletic Training, 52(4), pp.377–383. doi:https://doi.org/10.4085/1062-6050-52.2.06. ‌‌‌

t.Michelucci, A., Paolini, C., Boncompagni, S., Canato, M., Reggiani, C. and Feliciano Protasi (2017). Strenuous exercise triggers a life‐threatening response in mice susceptible to malignant hyperthermia. 31(8), pp.3649–3662. doi:https://doi.org/10.1096/fj.201601292r. ‌ Uchoa, R.B. and Fernandes, C.R. (2003). Rabdomiólise induzida por exercício e risco de hipertermia maligna: relato de caso. Revista Brasileira de Anestesiologia, 53(1), pp.63–68. doi:https://doi.org/10.1590/s0034-70942003000100009. ‌ Watt, S. and McAllister, R.K. (2023). Malignant hyperthermia. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK430828/. ‌ Hopkins, P.M. and Wappler, F. (2007). Is there a link between malignant hyperthermia and exertional heat illness? * COMMENTARY. British Journal of Sports Medicine, 41(5), pp.283–284. doi:https://doi.org/10.1136/bjsm.2006.032516. ‌ www.youtube.com. (n.d.). Malignant Hyperthermia in 3 Minutes. [online] Available at: https://www.youtube.com/watch?v=FvAg1t1wQiM [Accessed 5 Feb. 2023]. Larach, M.G., Brandom, B.W., Allen, G.C., Gronert, G.A. and Lehman, E.B. (2008). Cardiac Arrests and Deaths Associated with Malignant Hyperthermia in North America from 1987 to 2006. Anesthesiology, 108(4), pp.603–611. doi:https://doi.org/10.1097/aln.0b013e318167aee2. Oliveira, M.A.B. de, Brandi, A.C., Santos, C.A. dos, Botelho, P.H.H., Cortez, J.L.L. and Braile, D.M. (2014). Modes of induced cardiac arrest: hyperkalemia and hypocalcemia - literature review. Revista Brasileira de Cirurgia Cardiovascular. [online] doi:https://doi.org/10.5935/1678-9741.20140074 . Introduction. (2011). Available at: https://lms.resus.org.uk/modules/m10-v2-cardiac-arrest/10346/resources/chapter_12.pdf. ‌‌‌ ‌‌‌‌