A noninvasive investigation of muscle energetics supports similarities between exertional heat stroke and malignant hyperthermia

Exertional heat stroke (EHS) is usually triggered by strenuous exercise performed under hot and humid environmental conditions. Although the pathogenesis of an EHS episode differs from that of a clinical malignant hyperthermia (MH) crisis, both conditions share some similarities in symptoms, such as the abnormal increase in core temperature. By use of P-31 magnetic resonance spectroscopy, we analyzed the muscle energetics of 26 post-EHS subjects for whom in vitro halothane/caffeine contracture tests were abnormal and investigated possible similarities with subjects susceptible to MH. An early decrease of pH was noted during the first minute of exercise in EHS subjects as compared with controls. EHS subjects were divided into two subgroups according to the diagnostic score previously developed for MH subjects. The 19 subjects (73%) with a score higher than 2 displayed significantly larger caffeine-induced and earlier ryanodine-induced contractures on muscle biopsies as compared with the rest of the group (7 subjects). The results demonstrate that muscle energetics are abnormal in subjects who have experienced EHS and suggest a possible link between MH and EH, although all EHS cannot be considered as MH.