[The heart patient in the mountains: the behavioral indications].
Even today, a restrictive attitude frequently leads the physician to discourage the patient with cardiovascular abnormalities from sojourning at an altitude over 1000 m. This attitude, however, is not supported by any scientific proof. After a review of the major cardiovascular adaptations during high altitude exposure, we reported the principal studies of the effects of high altitude on patients with coronary heart disease, particularly during exercise. On the basis of personal experience and of other authors, we can state that the patient with ischemic heart disease, asymptomatic and with a recent clinical and functional evaluation, can stay in the mountains, even at altitudes of 2000-3000 m, and can hike and ski (cross-country and downhill). The risks appear to be related to factors independent of altitude, such as excessive cold or intense emotional stress due to dangerous situations, conditions that must consequently be avoided. On the other hand, an individual approach should be followed for the other congenital and acquired heart diseases, in which case we must consider, in addition to the clinical situation, some peculiar aspects of mountain environment (hypoxia, isolation, difficult access to medical facilities). Finally, the hypertensive patient, expected to have higher blood pressure values, especially diastolic, should frequently record his values during the first week at high altitude, eventually adjusting the therapy.
Ponchia
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Cattedra e Divisione di Cardiologia, Università degli Studi, Padova. aponchia@uxl.unipd.it
D000064:Acclimatization / Q000502:physiology; D000222:Adaptation, Physiological; D000531:Altitude; D015444:Exercise / Q000502:physiology; D006331:Heart Diseases / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D000860:Hypoxia / Q000503:physiopathology