Most people with heart disease can travel to high altitude: review

NEW YORK (Reuters Health) - Good news: people with heart disease dreaming of a vacation to a high-altitude destination can most likely make the trip safely.

Still, when venturing to high elevation, patients with heart conditions should follow some basic safety guidelines to help avoid and respond to emergencies, according to a recent review paper published by a group of U.S. and European physicians who specialize in mountain medicine.

There is a minority of people who should avoid high-altitude travel altogether, the authors say: those who become short of breath at rest or with minimal exercise at sea level. And people with less severe symptoms should still tailor their activities to their individual needs.

“While some may be able to climb, others should just visit a hut and enjoy a coffee and the landscape from there,” Dr. Thomas Kupper told Reuters Health in an email. He is one of the study’s authors and a sports medicine physician at Aachen Technical University in Germany.

The review was compiled with the goal of helping people with heart disease, including congestive heart failure - when the heart pumps too inefficiently to deliver blood to the body - and malformations of the heart that have been present since birth, known as congenital heart defects. The paper, published in the journal Travel Medicine and Infectious Disease, emphasizes preparing for travel to prevent emergencies, and also offers tips as to how to respond in an urgent situation.

“As with most things in life, common sense helps. If you’re out of shape and don’t exercise very often, it’s probably not a good idea to try to climb Mt. Everest,” said Dr. David O’Halloran, a cardiologist at Beth Israel Deaconess Medical Center in Boston. He was not involved in the study.

So-called high-altitude locations generally measure at least 2,500 meters - about 8,200 feet - above sea level. At that elevation, the atmosphere contains less oxygen, and the heart and lungs must adapt to supply the body with enough of the gas. Parts of the Rocky Mountains and Swiss Alps both measure over 4,000 meters above sea level.

The authors of the paper are members of the medical commission of the Union Internationale des Associations d’Alpinisme, also known as the International Mountaineering and Climbing Federation. The organization aims to promote the protection and growth of safe, responsible and ethical mountaineering.

People with heart conditions should seek medical advice from a doctor knowledgeable about altitude medicine, bring extra doses of regular medications and return to a lower altitude should they start having warning signs such as chest pain or shortness of breath, the authors say.

An important guideline says to avoid attempting feats at a high elevation that one couldn’t do at a lower one - advice that holds true for everyone, not just those with heart disease.

“It’s important for people who have had heart disease and are thinking about getting into an exercise program that they do so slowly, to build up tolerance,” O’Halloran told Reuters Health.

Another recommendation emphasizes allowing time for the body to acclimate to a higher altitude before attempting any heavy physical activity.

“The human body is capable of a lot of accommodation to different physiological and environmental circumstances, but you have to give it a chance to do that,” O’Halloran said.

Finally, travelers should be sure to venture out with at least one other person, according to the paper.

Some experts go farther, recommending having a buddy when starting a new exercise program in preparation for high-altitude travel.

That way, whether on a mountainside or on a treadmill, “if you run into trouble, there is someone there who could potentially help you,” O’Halloran said.

SOURCE: Travel Medicine and Infectious Disease, online March 2, 2014.