Travel Reference
In-Depth Information
such records when the individual is evacuated, and a detailed record may make possible a
prompt, accurate diagnosis by radio or cellular telephone.
HEART DISEASE IN THE WILDERNESS
Theterms sudden cardiac death, paroxysmal tachycardia, and acute myocardial infarction
confirm the unpredictable nature of heart disease. When asked to assess a person's risk for
participating in an adventure, physicians are being asked to predict that which is inher-
entlyunpredictable.Individualsoveragefiftywithmultipleriskfactorsforheartdiseaseor
with knownheart disease whoparticipate invigorousoutdooractivity without consulting a
physician place themselves, their companions, and success of the expedition at risk. In ad-
dition, they burden their companions with the possibility of having to care for an ill person
when they lack the appropriate skills.
An appropriate assessment of risk should be performed in persons over fifty years of
age, those with multiple cardiac risk factors (hypertension, diabetes mellitus, hypercholes-
terolemia, a history of smoking, or a family history of premature heart disease), and those
withknownheartdisease.Thisassessmentshouldbeperformedbyaphysicianwhoknows
the risks of the venture, the characteristics of the environment, and the physical demands
of the activity.
Thepre-adventure assessment shouldinclude adetailed medical history,including care-
ful questioning regarding risk factors for coronary artery disease. Functional status can be
ascertained by reviewing daily activities and the participant's history of previous adven-
tures. A past history of successful similar adventures is the strongest predictor of future
successinthewilderness.Thehistoryshouldbefollowedbyacarefulphysicalexamination
for evidence of hypertension, heart failure, abnormal rhythm, and atherosclerosis. Tests
such as ECGs, chest X-rays, and stress tests have relatively little predictive value except
possibly in those with known heart disease.
Much more important than testing is the strict adherence to a prescribed medical regi-
men. For example, cessation of medicines such as aspirin or statins (cholesterol-lowering
drugs) in persons with known coronary disease results in an increase in the risk of heart
attack at the time the drug is halted. In addition, the most common reason for individu-
als with heart failure to decompensate is failure to take their prescribed medicines. A pre-
scribed medical regimen must be followed in the wilderness, or risk is unnecessarily in-
creased. For complex adventures, this medical history and regimen must be reviewed with
the team leader. The participant must be vigilant for signs and symptoms of problems and
be honest and forthright in communicating them to the expedition leader.
Ultimately, the decision to participate in an activity must be a balance between risk and
desire. The unpredictable nature of heart disease means that although risk may be reduced,
itcannotbeeliminated.Mountaineeringandotherwildernessactivitiesremovethesecurity
of calling 911. Consequently, should an event occur, a favorable outcome is less likely.
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