Travel Reference
In-Depth Information
diac dyspnea), or sudden death. Rupture of one of these fat deposits results in clot forma-
tion, subsequent loss of blood flow, and myocardial infarction.
Angina Pectoris
Angina pectoris (or simply angina) is a sensation of pressure or deep-seated discomfort
beneath the sternum that characteristically appears during exercise and disappears after a
few minutes of rest. The discomfort may be described as crushing, a sensation of being
squeezed, feeling as if a weight were on the chest, feeling as if a band were around the
chest, or a deep-burning sensation. It may be felt in the neck, jaws, arms, or midback as
well as in the chest. If exercise is continued, the discomfort increases; pain is relieved by
rest and nitroglycerine. The discomfort is predictable and rarely occurs at rest except dur-
ing periods of emotional stress. If angina occurs at rest, this suggests an impending heart
attack. Its duration is rarely longer than fifteen to thirty minutes. Angina is frequently ac-
companied by shortness of breath, which subsides as the discomfort eases.
Individuals who have suffered episodes of angina must bring nitroglycerin tablets with
them into the wilderness. A person suffering angina should hold one of these tablets under
thetongueuntilithasdissolved.Twoorthreetabletstakenatthree-tofive-minuteintervals
may be necessary for relief. Nitroglycerin tablets should be kept in their original brown
glass bottle with a metal screw cap and should not be kept longer than six months after
purchase. Cotton wads shouldnotbekept inthe bottle, which shouldbetightly capped and
kept away from heat and moisture to reduce or prevent loss of potency.
Individuals with only mild angina at sea level may experience increased symptoms dur-
ing the first few days at higher altitudes. A decrease in physical activity, additional medic-
ations, and oxygen may be needed to control the symptoms. If the person has medications
such as beta blockers or calcium channel blockers, the dose may be cautiously increased.
However, if symptoms persist or occur at rest, the individual should descend (
Chapter 25:
Individuals with mild angina may take part safely in mildly strenuous outdoor activities
if they follow their physician's instructions, do not overexert, and carry nitroglycerine tab-
letstorelieveepisodesofpain.Theirlowriskforcatastrophiccardiaceventsmustbeestab-
lished by a physician. They should be able to carry out moderately strenuous, continuous
exercise, such as hill walking for several hours a day with minimal or no symptoms. Trips
to remote areas far from medical facilities or prompt evacuation are not advisable.
Individuals whodevelop angina forthe first time, orwhoexperience unusually frequent
or severe attacks of angina, should lie down, completely at rest, and should take nitrogly-
cerine if available. Because an initial episode of angina may not be clearly distinguishable
from an infarct, they should be given an adult aspirin, preferably a chewable tablet, but
any form suffices. Absolute rest should be continued for at least six to eight hours—longer
if the anginal episodes persist—after which the person should be evacuated with as little
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