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Association of ischemic electrocardiographic changes in high-altitude areas with coronary angiography

Krishan Lal1, Navreet Singh2, Anil Kumar3

  • 1SMO, HCMS, LNJP Civil Hospital, Kurukshetra, Haryana, India.

Medical Journal, Armed Forces India
|October 1, 2021
PubMed

Insights

High altitude (HA) exposure can cause electrocardiogram (ECG) changes in soldiers, but these changes rarely indicate underlying coronary artery disease (CAD). Coronary angiography (CAG) confirmed minimal CAD in soldiers with ECG abnormalities at HA.

Area of Science:

  • Cardiology
  • Altitude Medicine
  • Sports Cardiology

Background:

  • High altitude (HA) exposure can cause electrocardiographic (ECG) abnormalities in soldiers from lowland regions.
  • These ECG changes may mimic coronary artery disease (CAD), creating a diagnostic challenge.
  • HA exposure can precipitate myocardial ischemia in individuals with pre-existing CAD.

Purpose of the Study:

  • To correlate coronary angiography (CAG) findings with clinical and ECG diagnoses of CAD in soldiers exposed to HA.
  • To investigate the diagnostic dilemma posed by ECG changes at HA in the absence of overt symptoms.

Main Methods:

  • A prospective study involved 35 minimally symptomatic or asymptomatic soldiers with ECG changes suggestive of CAD.
  • These soldiers were referred from HA areas for evaluation at a near-sea-level center.
  • Coronary angiography (CAG) was performed to assess for evidence of CAD.

Main Results:

  • A significant association between CAG-diagnosed CAD and clinical/ECG diagnosis was not found (p = 0.697).
  • Only 4 out of 35 soldiers (11.4%) showed evidence of CAD on CAG.
  • Among minimally symptomatic subjects, only 4 out of 23 (17.4%) had CAD on CAG.

Conclusions:

  • Previously healthy individuals experiencing minimal symptoms and ECG changes at HA are unlikely to have significant coronary artery involvement.
  • Incidental ECG changes in asymptomatic soldiers at HA do not typically indicate underlying CAD.
  • The study highlights the need for careful interpretation of ECG findings in soldiers sojourning at high altitudes.
Abstract

Keywords:
Coronary angiographyCoronary artery diseaseElectrocardiographyHigh altitude

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