Travel Reference
In-Depth Information
Evaluation of Coronary Artery Disease in Individuals Over Age Fifty Who
Wish to Go to Altitude
Table 25-1
Heart Failure
A tendency toward acute decompensation in individuals with a history of heart failure
upon arrival to altitude has been observed, but systematic studies have not been made. Al-
though the hypoxemia of moderate altitude does not depress myocardial contractility, the
tendency toward fluid retention in some individuals at altitude—sometimes manifested as
AMS—could aggravate heart failure. Because such fluid balance changes may occur, per-
sons with heart failure must be cautious about altitude exposure. However, no data on the
magnitude of the risk or who would be most at risk are available.
Presumably, prevention and treatment at altitude would be the same as at sea level, al-
though low-flow oxygen would probably have greater benefit by reducing hypoxic stress.
Persons who know they have heart failure should consult their physician about increasing
theirdiureticmedicationataltitudeandshouldmonitortheirbloodpressureaswellastheir
weight, peripheral edema, and chest congestion.
Congenital Heart Disease
The hypoxia of high altitude elevates pulmonary arterial pressure and resistance. As a
result, individuals with disorders such as atrial and ventricular septal defects (abnormal
openingsbetweentherightandleftatriaorventricles),patentductusarteriosus(anopening
betweentheaortaandpulmonaryartery),andpartiallycorrectedtetrologyofFallot(acom-
plex congenital heart defect) might have increased pulmonary hypertension and shunting
from the pulmonary to the systemic circulation at high altitude. Children born at altitude
with atrial and ventricular septal defects have greater pulmonary hypertension than those
born at lower altitude. Whether such individuals develop greater arterial oxygen desatura-
tion at high altitude because the pulmonary hypertension of altitude increases shunting de-
pends on the severity of preexisting pulmonary hypertension and that induced by altitude
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