Coronary heart disease at altitude
1Department of Medicine, Baylor College of Medicine, Houston, Texas 77030.
Texas Heart Institute Journal
|January 1, 1994
Summary
Coronary patients face the highest risk of adverse events during the initial days at high altitude. Gradual ascent and controlled activity levels are crucial for their safety and acclimatization.
Area of Science:
- Cardiovascular Physiology
- Altitude Medicine
- Sports Cardiology
Background:
- Physiologic responses to altitude exposure in coronary patients were previously assumed similar to healthy individuals.
- Early ascent shows comparable sympathetic activation, heart rate, and blood pressure changes.
- Acclimatization involves decrements in plasma volume, cardiac output, and stroke volume.
Purpose of the Study:
- To review the known physiologic responses to altitude in coronary patients.
- To evaluate the risks and protective measures for coronary patients ascending to altitude.
- To provide guidelines for safe altitude exposure in this population.
Main Methods:
- Review of existing literature on altitude physiology and coronary patient responses.
- Analysis of clinical experience with coronary patients at varying altitudes.
- Discussion of risk stratification and precautionary measures.
Main Results:
- Coronary patients are at highest risk during the first 2-3 days at altitude.
- Gradual ascent, moderate conditioning, limited activity, and blood pressure control are protective.
- Asymptomatic or moderately tolerant patients face little risk at moderate altitudes with precautions.
- Pre-ascent testing may guide increased activity levels.
Conclusions:
- Ascent to moderate altitude is feasible for many coronary patients with careful management.
- High-risk patients require critical evaluation and rigorous precautions.
- Individual assessment is essential for patients considering very high altitude trekking, with limited current guidelines.
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