HEALTH PRESENTATION

CARDIAC ARREST DUE TO EXERCISE INDUCED MALIGNANT HYPERTHERMIA

Beyond the burn

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Case Studies and Prevention Strategies

Cardiac Arrest

Symptoms, Diagnosis, Treatment

Pathophysiology

Introduction and Understanding

By the end of this presentation you will :

Feel more confident

Discuss

Recall

Understand

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

Relevant case studies and prevention strategies including education

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

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

Understanding malignant hyperthermia

Introduction

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

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

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

Parallels

Exercise

Malignant Hyperthermia

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

The link between exercise and malignant hyperthermia

Pathophysiology

ATP

Muscles are activated so respiration is required

This leads to ATP depletion

Calcium

Abnormal ryanodine receptor in Sarcoplasmic reticulum in skeletal muscle

Releases an uncontrolled amount of mycoplasmic calcium

Membrane

This leads to hyperkalaemia and rhadbomyolysis

The muscles membrane integrity is compromised

Muscles

Muscles are activated in a hyper metabolic state

Biochemical processes set off by calcium imbalance

Mechanism of Malignant Hyperthermia

Symptoms and warning signs

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

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

Lack of acclimatisation and dehydration

Medical conditons

Warning signs and risk factors

Family and personal medical History

Rhabdomyolysis

DIC MODS

Inc. EtCO2Tachypnoea

RAT Rigidity Acidosis Temperature (high)

Rhabdomyolysis

Treatment

Sodium bicarbonate IV fluids Mannitol Rest

Diagnosis

Symptomatic diagnosis along with elevated CK .

Symptoms and causes

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

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

Dantrolene

Electrolytes

Heat control

STOP

Dantrolene is a drug that can be given in malignant hyperthermia

Try to optimise the electrolytes of the patient

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

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

Calcium Chloride and insulin and glucose for hyperkalaemia

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

Sodium bicarbonate

Other Medications for Treatment

Death

Coma

SIRS / MODS

DIC

Cardiac Arrhythmias

Rhabdomyolysis

HyperK

Clinical signs detected

Symptom Initiation

Exercise

cardiac arrest

Excess sweating

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

Hypoxia

Hypovolaemia

Cardio respiratory changes

Cardiac arrest

Altered cardiac contractility

Severe hyperkalaemia

ACIDOSIS

muscle breakdown

Increased arrhythmogenecity of cardiac sodium channels

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

NA

SIRS

Hyperthermia

Rhabdomyolysis

case studies

Stumbling and disoriented

No other members suffered

Rigidity

Temperature and acidosis (listed later)

How could his chances of survival been improved?

Follow the ALS algorithm in cardiac arrest

ALS

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

ROSC

Treatment

K+

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

CO2

Try and reach normocapnia by including hyperventilation

Dantrolene

Cooling

ERC Guidelines

RATS IN THE SHED

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

MENTIMETER CODE 22455927

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