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  • Patients & Relatives

    • What is MH?

      Malignant Hyperthermia is a genetic condition, usually triggered by anaesthetic drugs. It can be managed well if recognised and treated.
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      Testing for MH

      Anyone with suspected MH should undergo testing. A muscle biopsy test is currently the only definitive test for MH.
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    • Causes & Treatment

      The earliest signs of an MH reaction are an increased rate of metabolism and an increase in heart rate, during surgery.
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      FAQs

      Read our list of FAQs put together by patients and staff at the MH unit to give further support and information about the condition.
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    • Genetics of MH

      In most MH cases, the condition is inherited. The most common gene to be associated with MH is the RYR1 gene.
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      Ways to help

      The MH unit in Leeds is always pleased to hear from patients interested in fundraising or joining our patient liaison group to support others.
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  • GP’s

    • What is MH?

      Malignant hyperthermia (MH) is a progressive hyperthermic reaction occurring during general anaesthesia. If not treated well, the condition can prove fatal.
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      Patient referral information

      Please refer any patient with suspected MH to the specialist investigation unit in Leeds. Please ask patients to tell all relatives about their condition.
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    • Symptoms and implications

      MH is a genetic condition which is usually triggered when an individual is exposed to drugs which are commonly used in anaesthetics.
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      The UK MH Registry

      GPs should encourage any patient with confirmed or suspected MH to sign up to the UK MH Registry; an important research database of all known MH cases.
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    • Patient testing

      A definitive diagnosis of MH requires muscle biopsy testing, which can only take place at the specialist MH Investigation Unit at St James's Hospital, Leeds.
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      Contact details

      For further support and information, please call our Patient helpline number
      Tel: 0113 20 65270 (during office hours)
      Email: mhunit@leeds.ac.uk
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  • Pharmacists

    • What is MH?

      Malignant hyperthermia (MH) is a condition that only occurs under general anaesthesia. It can be fatal if it is not recognised and managed well.
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      Dantrolene

      Dantrolene is a hydantoin derivative that was originally developed for the treatment of muscle spasticity. It must be stocked on every site where general anaesthesia is administered.
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    • Symptoms and implications

      Exposure to inhalational anaesthetics can trigger a rapidly progressive and potentially fatal increase in metabolism, as can the neuromuscular relaxant, suxamethonium.
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      MH action plan

      Every hospital pharmacy and anaesthetic departments in every hospital should draw up an action plan to be used in an MH emergency.
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    • Treatment of MH

      Treatment of includes removal of the triggering drug, cooling of the patient and administration of the antidote, Dantrolene sodium.
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  • Nurses & Midwives

    • What is MH?

      Malignant hyperthermia is a life-threatening reaction to anaesthetic drugs. Between 1: 3,000 and 1: 10,000 people carry the genetic risk of developing malignant hyperthermia during anaesthesia.
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      Patients with a family history of MH

      In this situation the initial need is to clarify whether the patient is at risk of MH or not. This can be done by taking as detailed a family history as possible and then contacting the Leeds MH Unit.
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    • Anaesthetic pre-assessment

      It is important to be aware that patients who are susceptible to MH may not develop the condition every time they have a general anaesthetic.
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      MH and obstetrics for midwives

      MH safe anaesthetics need to be used if a MH susceptible pregnant woman requires anaesthesia or a pregnant woman whose partner is MH susceptible requires anaesthesia.
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    • Patients with a confirmed MH diagnosis

      These patients are often very well informed about their condition and its implications but may also be particularly anxious about receiving an anaesthetic.
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      Obstetric Care Plan

      A specific obstetric care plan needs to be devised for the MH susceptible parturient or the parturient with a MH susceptible partner.
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  • Operating Theatre Staff

    • Operating Theatre Staff

      It is vital that operating theatre staff are able to understand the signs of MH and their role in treatment of a crisis.
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      Malignant Hyperthermia & Symptoms

      Those at risk can receive anaesthetics safely as long as the inhalational anaesthetics and suxamethonium are avoided.
      Find out more

    • Managing an MH Crisis

      This page outlines what should be available for management of an MH crisis and should be fetched or ordered immediately. After stabilisation of the patient it is vital that the data from the monitor are stored and downloaded so that a retrospective record of events can be made.
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    • Preparing Known or Suspected Cases

      Any patient who is known to have MH, or is suspected of having MH, should be scheduled to be the first case on an elective list.
      The main principle of management of these patients is that they are not exposed to sufficient concentrations of triggering agents to risk the development of an MH reaction
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  • Geneticists

    • Susceptibility to MH

      MH susceptibility predisposes to a potentially fatal reaction to the most commonly used anaesthetic drugs.
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      Genes linked to MH

      Ryanodine receptor 1 (skeletal); RYR1 and Calcium channel, voltage-dependent, L type, alpha 1S subunit; CACNA1S
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    • Incidence of MH Reactions

      The number of new cases of malignant hyperthermia presenting with a clinical reaction has averaged approximately 25 per year over the last 10 years.
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    • Diagnostic Testing

      The diagnostic guidelines of the European Malignant Hyperthermia Group (EMHG) provide a framework that balances the definitive but invasive and more expensive in vitro contracture test with DNA testing which lacks sensitivity.
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  • Anaesthetists

    • Anaesthetists

      By definition MH can only occur under general anaesthesia. This is to distinguish it from other forms of heat illness, where an assessment of cerebral function is needed to make the diagnosis.
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      Malignant Hyperthermia

      Malignant hyperthermia is a life-threatening reaction to anaesthetic drugs. The term “malignant” hyperthermia arises from the progressive nature of the condition.
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    • Patients at Risk

      It is vital that all anaesthetists understand that a history of apparently uneventful general anaesthesia does not exclude underlying malignant hyperthermia susceptibility.
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      Managing Patients at Risk

      Once an increased risk of MH susceptibility is confirmed the management of anaesthesia is founded on the need to avoid exposure of the patient to triggering agents.
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    • MH During Anaesthesia

      The cardinal features of malignant hyperthermia result from an uncontrollable increase in intracellular calcium ions within the skeletal muscles.
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      Treatment of an MH Crisis

      An MH treatment algorithm should be prominently displayed or available in every location where general anaesthesia is administered.
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  • Neurologists

    • What is MH?

      By definition, malignant hyperthermia is characterised by a rapid, progressive, potentially fatal increase in body temperature that occurs in susceptible individuals during general anaesthesia.
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      Susceptibility to MH

      The great majority of patients susceptible to malignant hyperthermia have no neuromuscular symptoms or signs.
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    • Diagnosis of MH Susceptibility

      The preferred first line of investigation for a patient presenting to the neurology clinic with features associated with MH susceptibility is DNA analysis.
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      Diagnostic Testing

      When significance of a variant with respect to MH susceptibility is unknown, it is appropriate for the patient to be offered definitive testing for MH susceptibility using muscle biopsy and in vitro contracture tests.
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    • Useful References

      A 2009 issue of Anesthesia & Analgesia contained some interesting reviews on the relationship between MH and various muscle disorders.
      Find out more

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Neurologists

  • What is MH?
  • Susceptibility to MH
  • Diagnosis of MH Susceptibility
  • Diagnostic Testing
  • Useful References

What is MH?

By definition, malignant hyperthermia is characterised by a rapid, progressive, potentially fatal increase in body temperature that occurs in susceptible individuals during general anaesthesia.  It has the following International Classification of Disease codes:

– ICD-10 Code T88.3
– ICD -9 Code 995.86

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