The Coronary Stress of Skiing at High Altitude

Grover, Robert F.

doi:10.1001/archinte.1990.00390180045007

Cited by 19 publications

(4 citation statements)

References 13 publications

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“…For example, one study incorporating ambulatory monitoring of downhill skiers found that two‐thirds of individuals had an HR >80% of maximum predicted HR during exercise. 29 The only study evaluating individuals with preexisting arrhythmias but who were otherwise healthy, reported no worsening of arrhythmias up to altitudes of 4500 to 5056 m. 30 However, none of the participants had atrial fibrillation, and it is unknown whether altitude increases the burden of atrial fibrillation. In another study, there were no significant arrhythmias during symptom‐limited exercise at the Jungfraujoch (3454 m) in patients with a history of ACS who were evaluated 6 months after revascularization therapy if left ventricular function was normal and maximum exercise at low altitude was without signs of ischemia.…”

Section: Arrhythmias and Scd At Altitudementioning

confidence: 99%

“…Travel planning should include a few days of acclimatization with reduced or no exercise, particularly if individuals are unaccustomed to the type of activities planned. 29 In this case, the most effective measure of SCD prevention is regular pretravel exercise training and optimizing guideline‐directed medical therapy as indicated. In patients with pacemakers and implantable cardiac defibrillators, normal device function should be assured before traveling and patients made aware of potential mechanical interference with recreational equipment (eg, rucksack belt).…”

Section: Arrhythmias and Scd At Altitudementioning

confidence: 99%

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Clinical Implications for Exercise at Altitude Among Individuals With Cardiovascular Disease

Cornwell¹,

Baggish²,

Bhatta³

et al. 2021

JAHA

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An increasing number of individuals travel to mountainous environments for work and pleasure. However, oxygen availability declines at altitude, and hypoxic environments place unique stressors on the cardiovascular system. These stressors may be exacerbated by exercise at altitude, because exercise increases oxygen demand in an environment that is already relatively oxygen deplete compared with sea‐level conditions. Furthermore, the prevalence of cardiovascular disease, as well as diseases such as hypertension, heart failure, and lung disease, is high among individuals living in the United States. As such, patients who are at risk of or who have established cardiovascular disease may be at an increased risk of adverse events when sojourning to these mountainous locations. However, these risks may be minimized by appropriate pretravel assessments and planning through shared decision‐making between patients and their managing clinicians. This American Heart Association scientific statement provides a concise, yet comprehensive overview of the physiologic responses to exercise in hypoxic locations, as well as important considerations for minimizing the risk of adverse cardiovascular events during mountainous excursions.

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Section: Arrhythmias and Scd At Altitudementioning

confidence: 99%

Section: Arrhythmias and Scd At Altitudementioning

confidence: 99%

Clinical Implications for Exercise at Altitude Among Individuals With Cardiovascular Disease

Cornwell¹,

Baggish²,

Bhatta³

et al. 2021

JAHA

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“…It is important to emphasize, though, that patients may underestimate the intensity of exercise associated with some mountain activities. For example, Holter monitoring of downhill skiers showed that the majority of individuals achieved HR > 80% of predicted maximum (Grover et al, 1990). …”

Section: Provocable Ischemiamentioning

confidence: 99%

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.

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“…Dans un groupe de 1273 patients porteurs de maladies cardiaques diverses (parmi lesquels 141 avaient déjà fait un infarctus), un seul a souffert d'un nouvel infarctus lors d'un séjour entre 1500 et 3000 m [7]. Chez 149 skieurs étudiés par télémétrie entre 2500 et 3400 m (Colorado), l'incidence de variations anormales du segment ST était de 5,6 % chez les sujets de plus de 40 ans [8]. Ainsi, malgré le stress lié au froid, à l'altitude et à l'activité physique intense, l'incidence de signes d'ischémie à l'ECG n'était pas plus importante que chez des hommes asymptomatiques du même âge au niveau de la mer.…”

Section: Augmentation Du Débit Sanguin Cérébralunclassified

Altitude et système cardiovasculaire

Richalet

2012

La Presse Médicale

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The Coronary Stress of Skiing at High Altitude

Cited by 19 publications

References 13 publications

Clinical Implications for Exercise at Altitude Among Individuals With Cardiovascular Disease

Clinical Implications for Exercise at Altitude Among Individuals With Cardiovascular Disease

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

Altitude et système cardiovasculaire

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