Heat stress mimicking Acute Coronary Syndrome and progressing to convulsion in a remote oilfield worker

Heat stress is a serious occupational hazard, especially in hot environments such as oilfields. We report a 47-year-old male oilfield worker in southern Iraq who developed severe retrosternal chest pain and dyspnea, mimicking acute coronary syndrome, which rapidly progressed to a generalised tonic–clonic seizure. He was promptly managed at a remote rig clinic with intramuscular Midazolam, Oxygen, active cooling, and intravenous fluids. The patient stabilised within one hour and remained well after 24 hours of hospital observation. This case emphasises the need to consider heat stress in the differential diagnosis of chest pain in extreme occupational settings and highlights the potential for neurological complications.