Urban heat waves pose a significant threat to public health, food security, professional activities, and social interactions, particularly in rapidly urbanizing regions like Rajshahi City Corporation (RCC), Bangladesh. This study examines the knowledge, perceptions, and multidimensional impacts of heat waves on urban livelihoods, with a focus on developing a resilience framework to enhance adaptive capacities. Utilizing mixed-methods approach, the study reveals substantial awareness of heat wave occurrences, although preparedness and adaptation measures remain insufficient. Statistical analysis of temperature data from 1984 to 2023 highlights an increasing trend in heat wave periods, with April showing the most significant rise. Health impacts are profound, with increased incidences of heat-related illnesses and behavioral adjustments, while food security is compromised due to reduced agricultural productivity and nutritional deficits. Professional activities, particularly outdoor work, face severe disruptions, leading to economic instability. Social interactions are also affected, with reduced outdoor engagements and increased social isolation. The study underscores the necessity for comprehensive training programs, improved early warning systems, and robust policy interventions to mitigate heat wave impacts. A proposed livelihood resilience framework emphasizes integrated approaches encompassing health, food security, professional stability, and social cohesion.