Heart Problems in the Heat: Warning Signs You Shouldn't Ignore After 50

Heat & Heart Basics

Q: How does hot weather affect the heart, especially for older adults?

Robert Riekse, MD: As the weather gets warmer, your body makes several changes to help keep you cool. Blood vessels near the skin widen, allowing more blood to flow to the surface and release heat. Your body also produces sweat, which cools you down as it dries. As your body temperature rises, your heart has to beat faster and work harder to move blood around your body and help release heat. The hotter you get, the harder your heart and blood vessels have to work to keep your body cool. Because of this, extreme heat can be especially dangerous for people who already have heart disease or other heart and blood vessel conditions.

Q: Why are adults over 50 more vulnerable to heat-related illnesses like heat exhaustion or heat stroke? 

Robert Riekse, MD: There are several reasons why adults over 50 are more likely to develop heat-related illnesses. As we age, the body becomes less effective at cooling itself. Older adults often feel less thirsty, increasing the risk of dehydration and they may not sweat as much. Blood vessels can also become stiffer with age, making the heart work harder to help cool the body. In addition, some medications can affect how the body responds to heat and stays hydrated, including diuretics, beta blockers, antidepressants, sedatives and antipsychotics.

Q: What happens in the body during extreme heat that can strain the heart? 

Robert Riekse, MD: As an older adult becomes overheated, the heart has to work harder. Blood vessels widen to help release heat, which can make it harder for blood to return to the heart. As a result, the heart beats faster and works harder to keep blood flowing throughout the body. Sweating can also lead to fluid loss and dehydration, causing the body to respond by making the heart pump even harder. This increases the amount of oxygen the heart needs to do its job.

Warning Signs & When to Act

Q: What are the early warning signs of heat exhaustion people shouldn’t ignore?

Robert Riekse, MD: Early signs of heat exhaustion include fatigue, weakness, dizziness, nausea, headache, heavy sweating, muscle cramps and tachycardia. In heat exhaustion, a person may also begin to experience faulty-decision making.

Q: How can you tell the difference between heat exhaustion and heat stroke?  

Robert Riekse, MD: In heat stroke, a person's body temperature becomes dangerously high, rising above 104°F (40°C). As this happens, the brain can stop working properly, causing confusion and unusual behavior. A person may also have seizures. Heat stroke is a medical emergency and can lead to permanent damage to the body's organs or even death if not treated quickly.

Q: When should someone seek medical care instead of trying to cooling down at home?

Robert Riekse, MD: It is important to rapidly treat heat exhaustion so it does not lead to heat stroke. If there is a delayed response to treatment this can lead to worsening mental status. If there is any sign of confusion, this is a serious issue and may need additional aggressive medical care including the use of intravenous fluids and electrolyte replacement. Other important measures include removing the person from the heat, resting the person in a supine position and initiate cooling measures. This can include the use of fans and applying ice packs or cold towels to a person’s neck, wrists and forehead. 

Who's Most at Risk

Q: Who is most at risk for heat-related heart complications?

Robert Riekse, MD: Persons with preexisting cardiovascular disease and persons on certain medications are most at risk.  This includes our elderly.  Our elderly are also often isolated, lack mobility and may have a limited income to adapt to hot weather such as with the use of air conditioning. 

Q: Do common medications (like blood pressure meds or diuretics) increase risk in hot weather? If so, how? 

Robert Riekse, MD: Certain heart and blood pressure medications can make it harder for the body to handle hot weather. Beta blockers can limit how much the heart rate increases and can reduce blood flow needed to release heat. Diuretics, also known as water pills, can increase fluid loss, which may lead to dehydration and low electrolyte levels. Calcium channel blockers can affect how well the heart and blood vessels respond to heat. Some medications can also reduce sweating, making it harder for the body to cool itself.

Prevention & Smart Habits

Q: What are the best ways to protect your heart during a heat wave?

Robert Riekse, MD: The best ways to protect the heart is to stay cool with the use of air conditioning, maintaining adequate hydration limiting physical exertion during peak hot times and wear loose-fitting, light-colored clothing.

Q: Are there early signs of dehydration people should watch for?

Robert Riekse, MD: Early signs include being thirsty, dry mouth/lips, decreased urine output and darker urine color.

Q: When is the safest time of day to be active outdoors in the summer? 

Robert Riekse, MD: The safest time to be active outdoors is in the early morning hours or later in the day when the temperatures are cooler and the sun is not as intense.  This is typically before 10AM and after 4PM.

What to Remember

The best way to stay heart-safe in the heat is to stay cool.  Other important measures are to keep hydrated and limit exertion especially during peak hot times throughout the day.

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