Severe burns can trigger heart problems in victims, which may be a major cause of death, US experts say.
Death rates are high among those with bad burns, but doctors have often struggled to pinpoint the exact cause.
In a study of 189 children, a team from Shriners Hospitals for Children found those who suffered 80% burns had a "marked" reduction in heart function.
They also found burns in general put severe stress on other parts of the body, the Critical Care journal said.
"Unfortunately, little is currently known of the mechanisms leading to cardiac dysfunction"
When a person is burnt, a dramatic inflammatory response is triggered in the body, followed by a hypermetabolic response over the following days.
This response involves an increased metabolism - with a patient suffering 40% or more burns using up double or more the usual number of calories - and body temperature and severe fat and muscle wastage.
To meet the body's energy demands following a burn, the body uses up fat stores at a higher rate than usual.
The body's vital organs like heart and liver are then placed under stress and wounds take longer to heal, making the body vulnerable to infection.
Implications
In particular, the risk of cardiac dysfunction, which impacts on the regular beating of the heart, is raised.
Lead researcher Marc Jeschke said the findings had implications for the care of burns victims.
He said treatments should focus on a range of factors including inflammatory response, insulin resistance, hypermetabolism, catabolism, and heart problems.
And he added it was essential to have adequate cardiovascular support in place.
And Professor Jeremy Pearson, associate medical director at the British Heart Foundation, acknowledged strategies that protect the heart "may be important for survival".
"Unfortunately, little is currently known of the mechanisms leading to cardiac dysfunction, but we know that injuries cause our bodies to produce natural protection and defence molecules, which can inadvertently have damaging effects elsewhere."
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