Document Detail


Can patients with coronary heart disease go to high altitude?
MedLine Citation:
PMID:  20919884     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Tourism to high altitude is very popular and includes elderly people with both manifest and subclinical coronary heart disease (CHD). Thus, risk assessment regarding high altitude exposure of patients with CHD is of increasing interest, and individual recommendations are expected despite the lack of sufficient scientific evidence. The major factor increasing cardiac stress is hypoxia. At rest and for a given external workload, myocardial oxygen demand is increased at altitude, particularly in nonacclimatized individuals, and there is some evidence that blood-flow reserve is reduced in atherosclerotic coronary arteries even in the absence of severe stenosis. Despite a possible imbalance between oxygen demand and oxygen delivery, studies on selected patients have shown that exposure and exercise at altitudes of 3000 to 3500 m is generally safe for patients with stable CHD and sufficient work capacity. During the first days at altitude, patients with stable angina may develop symptoms of myocardial ischemia at slightly lower heart rate x  blood-pressure products. Adverse cardiac events, however, such as unstable angina coronary syndromes, do not occur more frequently compared with sea level except for those who are unaccustomed to exercise. Therefore, training should start before going to altitude, and the altitude-related decrease in exercise capacity should be considered. Travel to 3500 m should be avoided unless patients have stable disease, preserved left ventricular function without residual capacity, and above-normal exercise capacity. CHD patients should avoid travel to elevations above 4500 m owing to severe hypoxia at these altitudes. The risk assessment of CHD patients at altitude should always consider a possible absence of medical support and that cardiovascular events may turn into disaster.
Authors:
Christoph Dehnert; Peter Bärtsch
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  High altitude medicine & biology     Volume:  11     ISSN:  1557-8682     ISO Abbreviation:  High Alt. Med. Biol.     Publication Date:  2010  
Date Detail:
Created Date:  2010-10-05     Completed Date:  2011-01-20     Revised Date:  2011-05-13    
Medline Journal Info:
Nlm Unique ID:  100901183     Medline TA:  High Alt Med Biol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  183-8     Citation Subset:  IM; S    
Affiliation:
Internal Medicine II, Section of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany. christoph.dehnert@uniklinik-ulm.de
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MeSH Terms
Descriptor/Qualifier:
Acclimatization
Adaptation, Physiological
Aged
Altitude*
Altitude Sickness / etiology,  prevention & control*
Anoxia / prevention & control*
Cardiovascular Diseases / complications*,  physiopathology
Cardiovascular Physiological Phenomena
Health Knowledge, Attitudes, Practice*
Health Promotion / organization & administration*
Heart Failure / etiology,  prevention & control
Humans
Middle Aged
Patient Education as Topic
Risk Factors
Travel
Comments/Corrections
Comment In:
High Alt Med Biol. 2011 Spring;12(1):97-8; author reply 99-100   [PMID:  21452972 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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