Travel Reference
In-Depth Information
ful, particularly if blood pressure is high. Complete rest, sedation, oxygen, and a diuretic
aretheusualmethodsoftreatment.Individualsshouldbeevacuatedaftertwelvetotwenty-
four hours of rest with as little effort on their part as possible. If the dyspnea is severe,
oxygen and a strong analgesic should be given even though no pain is present.
At high elevations, high-altitude pulmonary edema should be considered, particularly if
the individual has no history of heart disease and has recently ascended to that elevation
(
Chapter 25: Altitude and Common Medical Conditions
)
. If high-altitude pulmonary ed-
ema is suspected, rest, oxygen, and assisted descent to a lower altitude are necessary.
Sudden Cardiac Death
Sudden cardiac death—instantaneous or within a few minutes of the onset of symp-
toms—is very rare in well-conditioned outdoor recreationalists who have never had symp-
tomsofheartdisease.Theunderlyingcauseinmostcasesisarterioscleroticcoronaryartery
disease, whichmaynothavebeensuspected bytheindividual orthephysician. Individuals
who have a family history of sudden death, have high blood pressure, smoke, have high
bloodcholesterolconcentrationsordiabetesmellitus,andhaveasedentarylifestylearepre-
disposed to coronary artery disease. Adherence to strict risk factor modification is the only
real deterrent to sudden cardiac death.
Valvular Heart Disease
Many persons who have deformities of heart valves that cause heart murmurs are cap-
able of strenuous physical effort without difficulty. However, with some types of valvular
heart disease, such activities may produce complications such as cardiac failure, atrial fib-
rillation, orstroke. Individuals with heart murmurs orvalvular heart disease shouldconsult
physicianstodetermine whetherornottheyshouldtakepartinwildernessactivities. Lead-
ers of an outing must be informed of that person's activity limits, medications to be taken,
and complications that might be expected.
Noncardiac Chest Pain
Chest pain in most individuals is not a sign of heart disease. The following are several
common types of chest pain not related to heart disease:
Aching and soreness due to muscular effort. After unaccustomed physical work in-
volvingthearmsandshoulders,suchasclimbing,crosscountryskiing,carryingaheavy
pack, or cutting wood, pain may be present in the upper chest muscles for two to three
days. The ache is usually constant and may be aggravated by motion, and the muscles
may be tender. Aspirin or acetaminophen, codeine, and rest are effective treatment. Re-
assurance should be provided.
Chest discomfort due to anxiety. Nervous, anxious, or fearful individuals may notice a
sensation of pressure in the chest that is associated with a sense of suffocation, trem-
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