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

Lal, Krishan; Singh, Navreet; Kumar, Anil; Agarwal, Naveen; Datta, R. Κ.; Datta, Rashmi; Bhardwaj, Prashant; Chadha, D.S.; Ak, Ghosh; Kumar, Rajesh

doi:10.1016/j.mjafi.2020.11.001

Cited by 2 publications

(3 citation statements)

References 15 publications

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“…Asymptomatic patients with incidental ECG abnormalities but no symptoms are very less likely to have CAD. 1 Although high-altitude populations do not have a high prevalence of coronary heart disease (CHD), electrocardiographic literature proposes that aberrant ECG abnormalities increase with altitude and risk pattern differs by ethnicity. 14 Contrary findings about the occurrence of risk factors for cardiovascular diseases in relation to altitude are found in data on cardiovascular mortality risk.…”

Section: Figure-ii: Coronary Angiography Findingsmentioning

confidence: 99%

“…High-altitude illnesses result in considerable morbidity and frequent hospital admissions. 1,2 Even internationally, studies involving high altitude and mountain medicine are not common because of access and presence of population at those heights. Various studies are now being performed to understand mountain medicine and effects of hypobaric hypoxia on individuals at high altitude.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10] Chest pain is the most common presenting complaint in patients at high altitude. 1,2 Electrocardiogram (ECG) is readily available and a relatively simple test done at first medical contact. 3 Interpretation of that ECG becomes important in deciding the urgency to evacuate patients from high altitude.…”

Section: Introductionmentioning

confidence: 99%

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Correlation of ECG changes at high altitude with findings on Coronary Angiogram.

Saif

Rahman²,

Liaqat³

et al. 2022

PAFMJ

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Objective: To highlight association of coronary artery disease on angiograms and high altitude-related ECG abnormalities that is thought to be ischemic in origin. Place and Duration of Study: This was a cross sectional study done in Armed Force Institute of Cardiology/National Institute of Heart Disease from Oct 2016 to Oct 2021. Methodology: This was a cross sectional study done in AFIC/NIHD from Oct 2016–Oct 2021 (5years). A total of 103 patients at a range of 9000 to 22000 feet in altitude, with new ECG changes were selected via consecutive sampling. Data was analyzed by SPSS version-23. Descriptive statistics were run to present categorical data in frequencies and percentages. Chi-square and Fisher Exact Test was applied to find the association between study variables at 95% CI and 5% margin of error (α= 5%). Results: The data was collected from a total of 103 respondents, mean age (years) of the respondents was 30.57±6.27, and mean duration of stay (days) at high altitude was 64.8±68.3 (Table-I). ECG changes that were recorded were: T-wave inversion in anterior leads (V1, V2, V3) were reported in n=33(32%), T- wave inversion in Inferior leads (II, III, aVF) in 21(20.3%), T-wave inversion in lateral leads (V3-V6) 10(9.7%). Normal Ejection fraction was observed in 97% of the study participants while only 3% had mild left ventricular systolic impairment. Angiographic findings were found to be normal in n=92 (89.30%), minor coronary artery disease (CAD) in n=9 (8.70%), muscle bridge in LAD in n=2 (1.90%). Our results also showed that amongst other final diagnosis, of note were vasovagal syncope (n=5; 4.8%), pulmonary embolism (n=5; 4.8%) and pulmonary arterial hypertension (n=3; 2.9%). Conclusion: Our work leads us to the conclusion that ECG abnormalities at high altitude do not indicate coronary artery disease since they do not reflect a delay in electrical conduction or ischemia. These patients should be treated separately based on their high altitude disease symptoms (HAI).

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Section: Figure-ii: Coronary Angiography Findingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Correlation of ECG changes at high altitude with findings on Coronary Angiogram.

Saif

Rahman²,

Liaqat³

et al. 2022

PAFMJ

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Acute Coronary Syndrome at Altitude: Diagnostic Dilemma on Aconcagua Using Point-of-Care Ultrasound

Sullivan,

Brillhart,

Duplessis

et al. 2024

Wilderness & Environmental Medicine

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At the Plaza de Mulas medical tent, located at 4300 m (14,100 ft) along the Normal Route to the 6960 m (22,837 ft) summit of Aconcagua in Argentina, a Korean male in his 50s with no known medical conditions presented with lightheadedness and shortness of breath. He had taken sildenafil and acetazolamide that morning without improvement. Vital signs on arrival were notable for oxygen saturations in the high 60s with basilar crackles on lung auscultation, concerning for high altitude pulmonary edema. The patient was started on oxygen via nasal cannula and given dexamethasone. History was limited secondary to language barriers, but on review of systems the patient noted mild chest pressure. Bedside cardiac echocardiogram was performed, which revealed a septal wall motion abnormality. The patient was therefore given aspirin and clopidogrel and was flown to a lower trailhead, where he was met by local Emergency Medical Services. A 12-lead electrocardiogram revealed an anterior ST-elevation myocardial infarction, and the patient was taken emergently to the catheterization lab in Mendoza and underwent stent placement with a full recovery.

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

Cited by 2 publications

References 15 publications

Correlation of ECG changes at high altitude with findings on Coronary Angiogram.

Correlation of ECG changes at high altitude with findings on Coronary Angiogram.

Acute Coronary Syndrome at Altitude: Diagnostic Dilemma on Aconcagua Using Point-of-Care Ultrasound

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