Hot weather isn’t just a matter of discomfort. It poses a serious threat to the heart and blood vessels. According to studies, a sharp increase in temperature raises the risk of heart attacks, strokes, and other complications by up to 30%. The elderly, patients with chronic diseases, and pregnant women are particularly vulnerable. How can we prevent cardiovascular complications in hot weather? Giorgi Choladze, an Academic Doctor of Medicine, Cardiologist, Cardiac Sonographer, Head of the Cardiology Department at Neolab Clinic, and Cardiologist at the Tbilisi Heart Center and Jerarsi Intensive Care Unit, answers Medscriptum’s questions.
Ekaterine Chitishvili: The air temperature is consistently high. According to CNN, this year alone, intense heat has claimed the lives of up to 2,300 people in European cities. Which categories of people find the heat particularly dangerous and difficult to tolerate?
Giorgi Choladze: First and foremost, these are elderly individuals, because the thermoregulation system of the aged population finds it very difficult to adapt to the ambient temperature. According to various data, the elderly, children, and pregnant women are the three most vulnerable groups. Consequently, they need to be more careful on hot summer days. Also, patients with kidney failure, diabetes mellitus, and various cardiovascular pathologies are of particular concern.
Ekaterine Chitishvili: How does heat affect blood pressure, and what advice do you have for people with hypertension?
Giorgi Choladze: For patients with arterial hypertension, blood pressure can actually drop below normal in the summer. Patients often receive adequate treatment, but because blood vessels dilate in the heat, blood pressure decreases, so dose correction is often necessary. People with hypertension must consult with their treating physician, especially at the beginning of summer. This is also the case with my patients. It is considered that every increase in temperature reduces arterial pressure by 5-10 mmHg. Fluids and electrolytes are lost, and as a result, hypotension (low blood pressure) develops. Therefore, these categories of patients definitely require constant monitoring and visits to their treating physician.
Ekaterine Chitishvili: Heart failure is a chronic disease; there are three forms: heart failure with preserved ejection fraction, heart failure with mildly reduced ejection fraction, and heart failure with reduced ejection fraction. Among these three forms, which group of patients is in the highest risk group, and what do you advise them?
Giorgi Choladze: First of all, we must take into account that the ejection fraction (how much blood is ejected by the heart into the body) is a very important parameter in cardiology. It is particularly important in assessing patients with heart failure. Unambiguously, patients with a reduced ejection fraction belong to the high-risk group. In such a case, since they already have a high risk of complications, the lower amount of blood ejected by the heart into the body at a specific time may be associated with ischemic cardiomyopathy (when the heart muscle does not receive enough blood), dilated cardiomyopathy (an enlarged heart), or valvular pathologies. This, in itself, increases the risk of complications. However, patients with even preserved ejection fraction are also of concern. In this case, special attention is paid to concomitant pathologies, such as the presence of arterial hypertension and diabetes mellitus.
Ekaterine Chitishvili: What factors mainly cause heart failure to worsen?
Giorgi Choladze: Hot weather creates a double threat for patients with heart failure. On the one hand, hypervolemia may develop, a condition where excess fluid accumulates in the body. At this time, fluid collects in the inferior vena cava, the pleura, and sometimes in the pericardium, as a result of which breathing becomes significantly more difficult and decompensation develops.
On the other hand, the opposite condition can also develop: dehydration. When there is a lack of fluid, the body tries to adapt. The heart tries to compensate with tachycardia, but the demand for oxygen increases, and the supply and consumption become imbalanced. As a result, hypotension (low blood pressure) appears, which ultimately further worsens heart failure. This is a well-known phenomenon, and consequently, paradoxically, the risk of decompensation of heart failure increases by 20-30% during the summer period.
Ekaterine Chitishvili: How important is it to visit a doctor and control medication dosages when the seasons change?
Giorgi Choladze: Many patients don’t understand that a visit to the doctor is necessary when the seasons change. Cardiovascular diseases are chronic processes and medications often need adjustment. For example, low blood pressure is common in the summer, especially in patients who take diuretics. In such a case, the doctor may change the doses of the medications so that the heat does not cause additional complications.
Ekaterine Chitishvili: Does heat change the effectiveness of medications?
Giorgi Choladze: Sometimes. Therefore, it is important to constantly monitor the patient’s condition. Especially in heart failure, regular ultrasound examination is desirable in order to see to what extent the body needs a diuretic or other medication. This decision is made only individually by the doctor.
Ekaterine Chitishvili: How often do people present with life-threatening problems in the summer?
Giorgi Choladze: Quite often. In the heat, the body loses fluids and electrolytes, creating an imbalance that increases the risk of thrombosis, stroke, and heart attack. Therefore, it is necessary to consume a sufficient amount of fluid.
Ekaterine Chitishvili: Which symptoms are the most alarming?
Giorgi Choladze: Sharp fluctuations in blood pressure, swelling of the legs, difficulty breathing, and an increased heart rate that no longer responds to medication. In such a case, you must definitely see a doctor.
Ekaterine Chitishvili: Is physical activity possible in the heat?
Giorgi Choladze: No, especially not for patients. It is better to do physical activity in the morning, when it is relatively cool. It is not recommended to be in the sun and walk for a long time. It is necessary to drink fluids, stay in the shade, and use air conditioning.
Ekaterine Chitishvili: What is sunstroke and how should we act in such a case?
Giorgi Choladze: This is overheating, when the body can no longer control its temperature. It manifests with dizziness, fatigue, nausea, and possible loss of consciousness. In such a case, the person should be moved to the shade, given fluids to drink, given cold compresses, and if necessary, call 112.
Ekaterine Chitishvili: How dangerous is it to suddenly move from a hot environment to a cold one?
Giorgi Choladze: Moving too quickly is not desirable. The body should cool down gradually. It is especially important for children, because their thermoregulation works weakly, so it is necessary to stay in the shade and bathe in water often.
Ekaterine Chitishvili: What should we know about first aid if someone loses consciousness due to the heat?
Giorgi Choladze: It is important for everyone to have a basic understanding of first aid methods, such as cardiopulmonary resuscitation (CPR). When a person has sunstroke, it is important to assess whether their consciousness is impaired. If, for example, the patient loses consciousness, the first thing to do is call 112. Then, move the patient to a safe environment, in the shade, lay them down, and slightly raise their legs to improve blood circulation to the brain. Cold compresses on the neck and armpits are helpful, as is providing fluids.
