Monday Medical: High altitude affects heart disease

Symptoms may become more prominent in the mountains

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Dr. Will Baker will speak on "Altitude and Heart Disease" at Yampa Valley Medical Center's free Taking Care of Me family health program at 7 p.m. Wednesday. He will offer advice on how to acclimate to higher altitude while visiting mountain areas, as well as provide tips for heart health while living at altitude. The program will be held in YVMC's Conference Room 1.

Exposure to high altitude can pose special problems to people with a history of heart disease. Although individuals with heart disease can enjoy the mountains, it is very important to be aware of altitude and its potential effects.

Symptoms of heart disease may become more prominent at high altitude. These might include chest pain, breathlessness, dizziness or fainting. Patients with "stable" symptoms at lower altitude may experience more severe symptoms while participating in lower than usual levels of activity.

Simply stated, altitude forces the heart to work harder. Although a healthy heart can respond to this demand, an individual who has blockages in the heart's blood vessels or a history of heart attack, heart failure or valve disease may find his or her heart becoming over-challenged.

Individuals with heart failure or weak hearts - especially those who often have lung congestion - tend to have the greatest difficulty with increased altitude. Because their hearts have limited ability to meet the increased demand, even a small amount of congestion in the lungs can reduce oxygen circulation significantly. Supplemental oxygen is likely to be required or increased.

Abnormal rhythms of the heart also are more common at altitude. Even healthy individuals may experience "skipped" heartbeats and periods of rapid heartbeats. This may lead to dizziness or, in severe cases, fainting. Individuals with a history of irregular heartbeats or abnormal rhythms may experience a worsening of symptoms at higher altitude.

Not only can heart disease itself cause problems, but the chronic treatments for heart disease also can contribute to the symptoms of high altitude. Many medicines used to treat high blood pressure or heart disease can keep the heart rate slow, which may worsen the sense of fatigue, breathlessness and dizziness. The effects of blood pressure medicines can change as well.

Dehydration is a common problem in the mountains. People lose more water through sweating and hyperventilation when they walk, bike, swim or enjoy other activities in the drier air. Diuretics or "water pills," often prescribed for heart problems, add to the dehydration process.

Even individuals without known heart disease may experience symptoms for the first time when exposed to a high-altitude environment. After all, the acute changes of high altitude are, in some sense, like a stress test.

If you have a history of heart disease, see your physician before traveling to a higher altitude. Your doctor can determine your risk for high-altitude travel and activities - including flying - and may want to make adjustments in your medicines.

Be sure to take your medicine as directed by your physician, and don't make changes without your physician's advice. In some cases, a diagnostic test might be recommended before traveling. Medicines such as acetazolamide might be prescribed to help decrease the effects of high altitude.

If you have no history of heart disease, it still is advisable to see your physician before traveling to high altitude, especially if you plan to participate in physical activities that are more strenuous than you may normally do. This is particularly true if you are on chronic medications or if you have risk factors for heart disease, such as older age, high blood pressure, diabetes, high cholesterol, smoking or a family history of heart disease.

Heart disease often develops "silently" and may not be evident until an individual is exposed to the stress of high altitude and physical activity.

With some forethought and guidance from a physician, as well as ample adjustment time to altitude, most individuals can experience an enjoyable and safe adventure in the mountains.

Will Baker, MD, FACC, is a cardiologist with Heart Center of the Rockies in Steamboat Springs.

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