High Altitude Cardiology

Optimize cardiac care for patients exposed to mountain altitudes Millions of travellers, athletes, and residents face cardiovascular challenges at high altitude each year, yet clinicians often lack specialized guidance for these patients. High Altitude Cardiology provides a comprehensive review of cardiac physiology and pathology related to altitude exposure. Written by a specialist in preventive cardiology and mountain medicine education, this reference synthesizes current knowledge for optimal patient care. The book examines cardiac adaptations in both normal and diseased hearts, covering hypertension, ischemic heart disease, heart failure, arrhythmias, and valvular conditions at altitude. Specialized chapters address considerations for pregnancy, paediatric & geriatric patients, and congenital heart diseases. Readers will find: Clinical case studies illustrating real-world presentations and management decisions in high altitude environments Evidence-based guidance on cardiovascular drug efficacy and safety in reduced oxygen environments Pre-exposure screening protocols to identify at-risk individuals before travel, trekking, or altitude relocation Synthesis of decades of research on cardiac physiology and disease management in mountain and high-altitude settings High Altitude Cardiology serves cardiologists, sports medicine physicians, general practitioners, and nurses who care for mountaineers, altitude travellers, and residents of elevated regions. Students in mountain medicine and cardiology courses will discover authoritative guidance for navigating altitude-related cardiac challenges.

FOREWORD v ABBREVIATIONS vi Part 1 Background 1 1 Definitions of Mountain Altitude 3 2 General Data, Relevance of the Problem 6 Part 2 Physiology of the Cardiovascular System at High Altitude 17 3 Cold Environment and the Heart 19 4 Altitude, Atmospheric Pressure and Physiopathological Phenomena on the Cardiovascular System 27 Everest without bottled Oxygen. A 'fair' ascent, for exceptional persons 42 5 Sympathetic Activation at Altitude and the Cardiovascular System 46 6 The Heart at High Altitude 54 High-altitude Pulmonary Oedema (HAPE), a case report from the past 67 7 Peripheral Vasoregulation 73 8 Effects of Exposure to Mountain Altitudes on Haematocrit and Consequences on the Heart and Circulation 78 A curious phenomenon in the high Alps: dehydration and 'evaporation' 85 Part 3 Travelling to High Altitude with Pre-existing Cardiac Diseases 89 9 Magnitude of Cardiovascular Risk Associated with Ascent to Altitude 91 10 Patients with Known Ischaemic Heart Disease and Physical Activity at Altitude 103 11 Mountain Altitudes and Patients with Heart Failure 115 12 People with High Blood Pressure Climbing to Altitude 122 Part 4 Other Cardiovascular Aspects of the Exposure to High Altitude 131 13 The Cardiovascular System of Pregnant Ladies at Altitude 133 14 Newborns and Children at High Altitude 141 15 Elderly Persons at Altitude 150 Two Popes and a President 152 16 Ascent to High Altitudes and Risk of Arrhythmias 157 17 Diabetes Mellitus and the Heart at High Altitude 163 Going High with diabetes mellitus. Useful tips from the diary of a mountaineer with type 1 diabetes 171 18 Prevention of Diseases related to High Altitude in Patients with Other Forms of Heart Disease 179 'A borrowed heart' at the top of Matterhorn, not to say of the other mountains 191 19 Pre-exposure Screening for High Altitudes 198 20 Prevention of Cardiovascular Diseases Through Activities at Altitude 214 21 Use of Drugs Acting on the Cardiovascular System at Altitude 227 22 Special Aspects of Basic Life Support at Altitude 245 APPENDIX 1 Classes of Recommendations and Levels of Evidence 257 APPENDIX 2 Self-evaluation (Available in e-book) 1 INDEX 259