Altitude and the heart: Is going high safe for your cardiac patient?

• Published in: The American heart journal 2010, Vol.159 (1), p.25-32
• Main Authors: Higgins, John P., MD, MPhil, Tuttle, Troy, MS, Higgins, Johanna A., MD
• Format: Article
• Language: English
• Subjects: Adaptation, Physiological; Adult; Age; Age Factors; Aged; Altitude; Altitude Sickness - epidemiology; Altitude Sickness - physiopathology; Atmospheric pressure; Binding sites; Biological and medical sciences; Cardiac arrhythmia; Cardiology. Vascular system; Cardiovascular; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - physiopathology; Female; Fitness equipment; Heart; Heart attacks; Heart rate; Hemodynamics - physiology; Humans; Hypoxia; Hypoxia - epidemiology; Hypoxia - physiopathology; Male; Medical sciences; Middle Aged; Oxygen; Oxygen Consumption; Physical Exertion - physiology; Pulmonary arteries; Risk Assessment; Safety; Sea level; Sex Factors; Sympathetic Nervous System - physiopathology; Travel; Young Adult
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2009.10.028

Our aging population combined with the ease of travel and the interest in high altitude recreation pursuits exposes more patients to the acute physiologic effects of high altitude and lower oxygen availability. Acute exposure to high altitude is associated with significant alterations to the cardiovascular system. These may be important in patients with underlying cardiovascular disease who are not able to compensate to such physiologic changes. Exacerbating factors pertinent to patients with cardiovascular disease include acute hypoxia, increased myocardial work, increased epinephrine release, and increased pulmonary artery pressures. This review summarizes the physiology and clinical evidence regarding acute altitude exposure on the cardiopulmonary system with practical recommendations to address the question: “Is it safe for me to ski in the Rockies or climb Mt. Kilimanjaro?”