High altitude, air travel, and heart disease
- Troy Tuttle, MS
Troy Tuttle, MS
- Exercise Physiologist
- Cardiovascular Division
- Asif Ali, MD
Asif Ali, MD
- University of Texas Health Science Center
- Cardiovascular Medicine
- David Filsoof, MD
David Filsoof, MD
- Cedars Sinai Heart Institute
- John Higgins, MD, MBA, MPHIL, FACC, FAHA, FACP, FACSM, FASNC
John Higgins, MD, MBA, MPHIL, FACC, FAHA, FACP, FACSM, FASNC
- Associate Professor of Medicine
- The University of Texas Health Science Center at Houston (UTHealth)
- Section Editors
- Heidi M Connolly, MD
Heidi M Connolly, MD
- Section Editor — Congenital Heart Disease
- Professor of Medicine
- Mayo Medical School
- David R Fulton, MD
David R Fulton, MD
- Section Editor — Pediatric Cardiology
- Associate Professor of Pediatrics
- Harvard Medical School
- Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Coronary Heart Disease; Myopericardial Disease
- Professor of Medicine
- Mayo Clinic College of Medicine
The number of individuals exposed to high altitude through air travel and recreational activities has been greatly increasing in the past few decades. Changes in physiological functions during high altitude exposure vary with an individual’s physical fitness, rate of ascent, severity and/or duration of exposure, cultural habits, geographical locations, and genetic variation . While high altitude is well tolerated by most individuals, patients with cardiovascular disease are at risk of complications caused by tissue hypoxia and reduced oxygen delivery, sympathetic stimulation, increased myocardial demand, paradoxical vasoconstriction, and alterations in hemodynamics that occur with exposure to high altitude [2-4]. The consulting physician should know the duration of travel, ascent profile, degree of exertion, and any prior cardiovascular history before traveling to high altitude.
High altitude provides a unique physiologic challenge to the cardiovascular system. The cardiovascular response to high altitude in both healthy individuals and in patients with cardiovascular disease will be reviewed here. A general overview of high altitude disease will also be included to provide a comprehensive understanding. (See "High altitude illness: Physiology, risk factors, and general prevention".)
Most importantly, this topic will discuss the impact of high altitude on the heart. Altitude exposure can also lead to a variety of well-described clinical syndromes including some not directly involving the cardiovascular system, such as acute mountain sickness, high altitude pulmonary edema, high altitude cerebral edema, and high altitude retinal hemorrhage. These maladies are discussed in detail within this report. (See "High altitude pulmonary edema" and "Acute mountain sickness and high altitude cerebral edema" and "High altitude illness: Physiology, risk factors, and general prevention", section on 'Other altitude-related illnesses'.)
BAROMETRIC PRESSURE AND PIO2
When moving from sea level to high altitude, there are reductions in atmospheric pressure, oxygen pressure, humidity, and temperature . It is noteworthy to point out that significant changes occur beyond the critical height of 2500 meters (8200 feet) above sea level . Factors such as degree of change in elevation, degree of hypoxia, rate of ascent, level of acclimatization, exercise intensity, previous history of severe high-altitude illness, genetics, and age significantly affect the physiological change that the human body will experience during ascents . One study involving Chinese men aged 18 to 35 years noted that increased age (those 26 to 35 years old) was an independent risk factor for acute mountain sickness upon rapid ascent to high altitude (from 500 to 3700 m), and that the prevalence of acute mountain sickness also increased with increasing age . Hypoxia induces peripheral vasodilation and a pulmonary vasoconstriction, leading to changes in systemic blood pressure and an increase in pulmonary blood pressure that can also contribute to a high altitude pulmonary edema.
Although altitude is the most obvious determinant of barometric pressure and its resulting physiologic stress, other factors can contribute to a reduction in barometric pressure and can increase the physiologic consequences of altitude:
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- BAROMETRIC PRESSURE AND PIO2
- NORMAL CARDIOVASCULAR RESPONSE TO HIGH ALTITUDE
- Short-term altitude exposure
- Long-term altitude exposure
- ALTITUDE STRESS IN HEART DISEASE
- Coronary heart disease
- - Patients without diagnosed CHD
- - Summary
- Heart failure
- - Our approach
- Valvular heart disease
- - Summary
- - Summary
- Pacemaker function
- Congenital heart disease
- - Summary
- AIR TRAVEL
- Potential risk
- Incidence of problems
- - Supplemental oxygen
- - Stable coronary artery disease
- - Myocardial infarction
- - Percutaneous coronary intervention
- - Coronary artery bypass graft surgery
- - Implanted devices
- - Deep vein thrombosis and pulmonary embolism
- TREKKING AND MOUNTAINEERING