August 04, 2008
Is It Too Hot for Your Heart?

McKinney Courier-Gazette Star interviews Dr. Akram Kahn about what coaches, parents and kids alike should know about how extreme heat can exacerbate health problems - especially an underlying problem with the heart.
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As the summer skies heat up over Texas, I am bracing for the untimely death of a young athlete - a teenage boy or girl who collapses on the basketball court or the football field.

It happens every summer. But, it doesn’t have to.

Coaches, parents and kids alike should know extreme heat can exacerbate any health problem - especially an underlying problem with the heart. Most young athletes who die from sudden cardiac death fall victim to hypertrophic cardiomyopathy - a condition in which the heart muscle becomes thick and struggles to work. The condition is usually congenital, and not detected at birth.

In a recent study in the Journal of the American College of Cardiology, electrocardiograms were performed on 2,000 professional football players. Some 24 percent showed mild to distinct cardiac abnormalities. Think about that. That’s just one small study in a single sport. If this trend is consistent for high school and collegiate football players, 24 percent of the kids who play sports could be at risk.

Unlike professional sports, there is no screening system in place in American schools. That means most parents won’t know if their child has a heart-related problem until it’s too late. Comparably, Italy has a screening system in place and the lowest child mortality rate in the world.

I recommend every child be screened. It’s as simple as EKG and an ultrasound. Both are non-invasive procedures that could mean the difference between a winning athlete and the loss of a child. Parents, teachers and coaches should be aware that extreme heat can be dangerous for even a HEALTHY child, and should talk to children about the risks involved.

Each one of us has an inner core temperature that our brain recognizes. It’s what enables humans to live under extreme temperatures ranging from Antarctic cold to desert hot. Our body’s fatty tissues help to keep us warm in wintry conditions, and our skin’s ability to sweat helps to cool us when overheated.

But, sometimes we can get too hot - and fall victim to heat cramps, heat exhaustion or even heat stroke. Heat related illnesses occur when your body can’t keep itself cool. The hot, humid summer days in Texas are particularly dangerous because the evaporation of sweat is slowed by the increased moisture in the air.

Heat exhaustion can be caused by exercise, hot weather or a combination of both. You may feel weak or dizzy and have a headache. If it is not treated, heat exhaustion can lead to heat stroke.

Heat stroke is the most dangerous of the heat-related illnesses. It can strike suddenly and with little warning. During a heat stroke, the body’s cooling systems fails; the core temperature rises quickly; and blood pressure bottoms out. It’s as if headquarters - your brain - has lost connection with the troops. In this case - the blood vessels, the liver, the kidneys and the muscles. It can take hours to reach the precipice of a heat stroke, but once you’ve hit that threshold, it can be fatal within minutes.

Every coach, parent and teacher should know the symptoms and what to do to avoid it.

The main sign of heat stroke is a markedly elevated body temperature - generally greater than 104¡F - with changes in mental status ranging from confusion to coma. Skin may become hot and dry.

When it comes to school sports, teaching kids the warning signs isn’t enough. I believe the coach has the first responsibility.

Coaches should know the outdoor temperature, and be willing to change the regimen in accordance with the heat… modify the workout, postpone it, or practice in a covered arena. Take good breaks, and balance hydration with electrolytes - electrically charged ions that help regulate the internal environment of the body.

When it comes to hydrating in the heat, Gatorade and fruit juices - especially orange juice - are better than water. Both contain potassium and glucose. You can easily sweat out several liters of water while exercising in the heat. But, you’re not just losing water; you’re losing potassium - an electrolyte that helps sustain your heart. It’s the same reason athletes can suffer heat cramps.

Kids should know to keep an eye on their urine. If it’s clear, you’re properly hydrated; if it’s yellow, you should drink more - preferably juice. And, if you feel thirsty, you’re already dehydrated. Never let thirst be an indicator of when you might need a drink.

Bottom line: there is no reason for extreme exercise in extreme heat. I call that crazy. Exercise is supposed to be good for you. Exercising in extreme heat is an exercise in insanity.

Dr. Akram Khan has been practicing cardiovascular medicine in McKinney since 1997. He recently started the Center for Preventive Medicine in McKinney . For more information, visit www.savingtheheart.com. Contact him at 214-544-6040 or arhum2000@hotmail.com.

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