Can my patient with CVD travel to high altitude?

Abstract

Patients with borderline health should consult a physican before travelling to altitude. The physician will need to know the duration of the trip, ascent profile and how much exercise the patient plans to undertake. The presence of comorbid diseases which reduce oxygenation and ventilation should also be taken into account. Every patient must be assessed on an individual basis, there are no clinical investigations which reliably predict outcome at altitude. Complex cases may require advice from the patient's cardiologist. Travelling from sea level to an altitude of 2,500 m causes a 20% reduction in the partial pressure of inspired oxygen. There is an initial net increase in myocardial oxygen consumption during the first 3-5 days, this then falls as cardiac output on exercise is reduced. During this time patients with angina pectoris may become symptomatic at a lower level of exercise than at sea level and should be advised to reduce their activity. After five days at 2,500 m, the exertion threshold returns to sea level values. Patients should not travel to high altitude immediately after an acute coronary syndrome. Most patients with stable coronary artery disease with a sufficiently high exercise capacity at sea level can go as high as 3,000-3,500 m with only a minimally increased risk. Patients with heart failure have a greater reduction in exercise performance than healthy people at altitude. Patients with mild to moderately impaired systolic LVF and mild symptoms may travel up to 3,000-3,500 m for a day trip. Patients with poorly controlled hypertension should not travel to high altitude. Those with controlled hypertension should consider taking their own blood pressure during a stay at altitude.