Does Cardiovascular Medication Increase Heat Stroke Risk?

Q: Does Cardiovascular Medication Increase Heat Stroke Risk?

Hello： <br>1. <br>The medications you are taking that are more likely to cause discomfort in your body include： <br> - Isosorbide Dinitrate： Its primary function is vasodilation, and it may cause side effects such as dizziness, palpitations, and hypotension, among others.<br>

Does taking cardiovascular medications increase the risk of heat stroke?

Hello Dr.
Lin, in 2015, I was diagnosed with left coronary artery atherosclerosis.
In 2020, due to atrial fibrillation, I underwent two catheter ablation procedures.
Since then, I have been taking five medications: (1) Isosorbide dinitrate (Esmolol), (2) Apixaban (Eliquis), (3) Metoprolol (Lopressor), (4) Amiodarone (Cordarone), and (5) Clopidogrel (Plavix).
This summer, possibly due to the hot weather, I experienced dizziness, headaches, nausea, and pale complexion on two occasions.
During the first episode, I went to the emergency room, and all physical examinations were normal.
The physician suggested drinking sports drinks and arranged for two neurological tests, which also came back normal.
I would like to ask if taking cardiovascular medications makes it easier to suffer from heat-related illnesses, and what the reasons might be.
Should sports drinks be consumed only when feeling unwell, or can they be consumed regularly? How much should one drink to avoid overconsumption or underconsumption? Thank you for your guidance.

Retired Person, 70~79 year old female. Ask Date: 2023/09/15

Dr. Lin Zhebin reply Family Medicine

Hello:
1.
The medications you are taking that are more likely to cause discomfort in your body include:
- Isosorbide Dinitrate: Its primary function is vasodilation, and it may cause side effects such as dizziness, palpitations, and hypotension, among others.
- Propafenone: Its main action is antiarrhythmic, and it may also lead to side effects like dizziness and hypotension, among others.
- Bisoprolol: Its role is to protect the heart and reduce heart rate, which may result in side effects such as dizziness, bradycardia, and hypotension, among others.
Hot weather can lead to increased sweating and dehydration, which may cause hypotension.
Combined with the effects of the aforementioned medications, this could exacerbate your low blood pressure and result in discomfort.
2.
Regarding sports drinks, my main concern is the sodium and sugar content, which are usually high.
Given your heart condition, it is important to avoid excessively high blood pressure; elevated sodium levels could lead to abnormal blood pressure.
Additionally, long-term high sugar intake may lead to blood sugar issues (e.g., diabetes), which can also affect your heart.
3.
In summary, I recommend that you follow up with your physician to discuss possible adjustments to your medications to alleviate your discomfort.
Furthermore, sports drinks are generally advised for consumption after high-intensity exercise or significant sweating, when there is a greater likelihood of electrolyte and sugar depletion.
If you are adequately hydrated, it is not necessary to consume them regularly.

Reply Date: 2023/09/15

More Info

The concern regarding whether cardiovascular medications increase the risk of heat stroke is valid, especially for individuals with pre-existing conditions such as coronary artery disease and atrial fibrillation. The medications you mentioned, including Isosorbide Dinitrate (易適倍), Propafenone (律諾), Bisoprolol (康肯), and others, can indeed have side effects that may contribute to symptoms resembling heat-related illnesses, particularly in hot weather.

Understanding the Risk
1. Mechanism of Action: Many cardiovascular medications work by altering blood pressure and heart rate. For instance, Isosorbide Dinitrate is a vasodilator that can lower blood pressure, while Bisoprolol is a beta-blocker that reduces heart rate. In hot weather, the body naturally dilates blood vessels to help dissipate heat, which can lead to lower blood pressure. When combined with the effects of these medications, there is a potential for significant hypotension (low blood pressure), which can cause symptoms like dizziness, nausea, and fainting.

2. Dehydration: Hot weather often leads to increased sweating and fluid loss. If you are not adequately hydrated, this can exacerbate the hypotensive effects of your medications. Dehydration can also impair the body's ability to regulate temperature, increasing the risk of heat-related illnesses, including heat exhaustion and heat stroke.

3. Symptoms: The symptoms you experienced—dizziness, nausea, and pale complexion—are indeed concerning and can be indicative of heat exhaustion or hypotension. It is crucial to monitor these symptoms, especially during periods of high heat.

Recommendations
1. Hydration: It is essential to stay well-hydrated, particularly in hot weather. While sports drinks can help replenish electrolytes, they often contain high levels of sugar and sodium, which may not be ideal for someone with cardiovascular issues. Instead, consider drinking water regularly throughout the day. If you engage in prolonged physical activity or excessive sweating, a sports drink may be beneficial, but moderation is key. Aim for a balance that maintains hydration without excessive sugar or sodium intake.

2. Monitoring Symptoms: If you feel unwell, it is advisable to drink fluids and rest in a cool environment. If symptoms persist or worsen, seek medical attention promptly.
3. Medication Review: Given your history and current symptoms, it may be beneficial to discuss your medication regimen with your healthcare provider. They may consider adjusting dosages or switching medications to minimize side effects, especially during the hotter months.

4. Avoiding Heat Exposure: Try to limit exposure to high temperatures, especially during peak heat hours. If you must be outside, wear light, breathable clothing and take frequent breaks in shaded or air-conditioned areas.

5. Regular Check-ups: Regular follow-ups with your healthcare provider are essential to monitor your cardiovascular health and medication effects, especially as the seasons change.

Conclusion
In summary, while cardiovascular medications can contribute to an increased risk of heat-related illnesses due to their effects on blood pressure and heart rate, proper hydration, monitoring of symptoms, and medication management can help mitigate these risks. Always consult with your healthcare provider for personalized advice and adjustments to your treatment plan, especially in response to environmental changes or new symptoms.

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