Sleeping altitude and sudden cardiac death

Lo, Monica; Daniels, James; Levine, Benjamin D.; Burtscher, Martin

doi:10.1016/j.ahj.2013.04.003

Cited by 33 publications

(29 citation statements)

References 17 publications

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“…Exposure to hypobaric hypoxia can consequently result in exaggerated arterial hypoxemia and lead to cardiac dysfunction including SCD [2, 19]. In this study, we showed that RCE significantly normalized the decrease in phosphorylation of eNOS produced by hypoxia.…”

Section: Discussionsupporting

confidence: 54%

“…These events may even have lethal consequences [1]. In addition to the pulmonary alterations, sudden cardiac death (SCD) is another common cause of death that is associated with vasoconstriction and pulmonary hypertension and even more rapid lethality during high-altitude activities [2]. Hypobaric hypoxia is considered as a cardiac stressor and may lead to some cardiovascular disorders such as myocardial infarction (MI) and pulmonary hypertension-induced right ventricular (RV) dysfunction [3].…”

Section: Introductionmentioning

confidence: 99%

“…Hypobaric hypoxia is considered as a cardiac stressor and may lead to some cardiovascular disorders such as myocardial infarction (MI) and pulmonary hypertension-induced right ventricular (RV) dysfunction [3]. In individuals with heart disease, hypoxic conditions also decrease the ischemic threshold and increase the arrhythmia frequency [2]. Thus, the impact of hypobaric hypoxia on the heart has been a focus of investigation in recent years.…”

Section: Introductionmentioning

confidence: 99%

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Rhodiola crenulata extract counteracts the effect of hypobaric hypoxia in rat heart via redirection of the nitric oxide and arginase 1 pathway

Hsu

Chang

et al. 2017

BMC Complement Altern Med

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Background Rhodiola crenulata is traditionally used as a folk medicine in Tibet for preventing high-altitude illnesses, including sudden cardiac death (SCD). The cardio-protective effects of Rhodiola crenulata root extract (RCE) against hypoxia in vivo have been recently confirmed. However, the way in which RCE produces these effects remains unclear. The present study is designed to confirm the protective effects of RCE on the heart in acute hypobaric hypoxia exposure and examine the mechanisms by which this occurs.MethodsSprague–Dawley (SD) rats were pretreated with or without RCE and then exposed to a simulated altitude of 8000 m in a hypobaric hypoxia chamber for 9 h. The expression of cardiac arginase 1 (Arg-1) and endothelial nitric oxide synthase (eNOS) and the activity of associated signaling pathways was examined.ResultsHypoxia reduced cardiac eNOS phosphorylation and increased Arg-1 expression, but both responses were reversed by RCE pre-treatment. In addition, RCE decreased the hypoxia-induced oxidative stress markers of reactive oxygen species (ROS) production, malondialdehyde (MDA) level, and protein carbonyl content. Furthermore, RCE protected cardiomyocytes from hypoxia-induced cardiac apoptosis and restored the phosphorylation level of AKT and p38 MAPK as well as the superoxide dismutase 2 (SOD2) content in hypoxic animals.ConclusionThe findings provide evidence that the effects of Rhodiola crenulata against altitude illness are partially mediated by modulation of eNOS and Arg-1 pathways in the heart.Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-016-1524-z) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Rhodiola crenulata extract counteracts the effect of hypobaric hypoxia in rat heart via redirection of the nitric oxide and arginase 1 pathway

Hsu

Chang

et al. 2017

BMC Complement Altern Med

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“…Increasing altitude alters oxygen availability and acutely increases the heart rate and cardiac output for any given absolute work rate. 19 In patients with underlying coronary heart disease, it may also reduce the myocardial workload required to cause ischemia 20 and increase the risk of sudden death, 21 although even short-term acclimatization appears to reduce this risk significantly. 21 Heat is also a substantial stressor; because humans thermoregulate by sending blood to the skin, a large extra amount of cardiac output is required to maintain body temperature, 22 and this could increase the dynamic classification of some sports (especially "hot yoga").…”

Section: Classification Of Sportsmentioning

confidence: 99%

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 1: Classification of Sports: Dynamic, Static, and Impact

Levine,

Baggish,

Kovacs

et al. 2015

Circulation

Self Cite

137

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“…Most recently, the Burtscher group has shown that even one night of acclimatization at an altitude > 1300 m prior to exercising at altitude may lead to a nearly 6-fold reduction in the risk of sudden cardiac death in the mountains (Lo et al, 2013) Therefore, fitness and acclimatization remain the best protective measures to limit the risk of adverse events at high altitude in patients with CAD.…”

Section: Sudden Cardiac Deathmentioning

confidence: 97%

Going High with Heart Disease: The Effect of High Altitude Exposure in Older Individuals and Patients with Coronary Artery Disease

Levine

2015

High Altitude Medicine & Biology

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Levine, Benjamin D. Going high with heart disease: The effect of high altitude exposure in older individuals and patients with coronary artery disease. High Alt Med Biol 16:89-96, 2015.--Ischemic heart disease is the largest cause of death in older men and women in the western world (Lozano et al., 2012 ; Roth et al., 2015). Atherosclerosis progresses with age, and thus age is the dominant risk factor for coronary heart disease in any algorithm used to assess risk for cardiovascular events. Subclinical atherosclerosis also increases with age, providing the substrate for precipitation of acute coronary syndromes. Thus the risk of high altitude exposure in older individuals is linked closely with both subclinical and manifest coronary heart disease (CHD). There are several considerations associated with taking patients with CHD to high altitude: a) The reduced oxygen availability may cause or exacerbate symptoms; b) The hypoxia and other associated environmental conditions (exercise, dehydration, change in diet, thermal stress, emotional stress from personal danger or conflict) may precipitate acute coronary events; c) If an event occurs and the patient is far from advanced medical care, then the outcome of an acute coronary event may be poor; and d) Sudden death may occur. Physicians caring for older patients who want to sojourn to high altitude should keep in mind the following four key points: 1). Altitude may exacerbate ischemic heart disease because of both reduced O2 delivery and paradoxical vasoconstriction; 2). Adverse events, including acute coronary syndromes and sudden cardiac death, are most common in older unfit men, within the first few days of altitude exposure; 3). Ensuring optimal fitness, allowing for sufficient acclimatization (at least 5 days), and optimizing medical therapy (especially statins and aspirin) are prudent recommendations that may reduce the risk of adverse events; 4). A graded exercise test at sea level is probably sufficient for most clinical decision making and will allow for assessment of exercise capacity, and provocable ischemia. Given these considerations, most older individuals with CHD should be able to tolerate exposure to high altitude safely, and with minimal increased risk.

show abstract

Sleeping altitude and sudden cardiac death

Cited by 33 publications

References 17 publications

Rhodiola crenulata extract counteracts the effect of hypobaric hypoxia in rat heart via redirection of the nitric oxide and arginase 1 pathway

Rhodiola crenulata extract counteracts the effect of hypobaric hypoxia in rat heart via redirection of the nitric oxide and arginase 1 pathway

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 1: Classification of Sports: Dynamic, Static, and Impact

Going High with Heart Disease: The Effect of High Altitude Exposure in Older Individuals and Patients with Coronary Artery Disease

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