Heart Attack Deaths at Elevation in Visitors

Last year in Summit County, 23 people died of heart complications, 19 of which were visitors ascending to higher altitude.  Most of these visitors were in their 50s or older and died within one to two days after coming to elevation (Queen, 2017).

Acute exposure to high altitude over 2500 m can cause great strain on the body and is associated with significant alterations to the cardiovascular system such as tissue hypoxia and increased pulmonary artery pressures.  Although the concentration of oxygen at elevation is the same at sea level, the air is thinner causing less oxygen to breath.  At sea level the percent of effective oxygen concentration is around 20% where as in Summit County the percentage of effective oxygen drops down to 14%.  At higher elevation such as the ski areas the percentage of effective oxygen drops down to 13% (Queen, 2017).  As a result, the heart will pump faster to increase the delivery of oxygen to the body.  The cardiac stress at rest is minimal, however it can be significant during exercise.  Anyone with some degree of heart complication can worsen the stress on their heart when coming to higher elevation (Bach, 2013).

Hypoxemia due to high altitude can cause poor oxygenation of the lungs and constriction of blood vessels, causing an increase in pulmonary pressure and increasing hypertension.  Therefore, an acute exposure to high altitude can cause cardiovascular stress.  Residents of high elevation tend to do better because they have anatomical and physiological changes in their cardiovascular system that allows them to adapt to high-altitude chronic hypoxia (Hurtado et al., 2012).

It is recommended that any patients with cardiovascular disease who are from sea level and planning to come to elevation should slowly acclimatized themselves by staying in Denver for a day or two prior to going above 2500 m.  Patients who have stable heart complications should limit their physical activity for the first few days after ascending to elevation.

Hong Nguyen, PA-S

Physician Assistant Student

Red Rocks Community College

References:

Reference:

Bach, D. (n.d.). Altitude and the Heart: Is Going High Safe for Your Cardiac Patient? Retrieved March 28, 2017, from http://www.expeditionmedicine.co.uk/index.php/advice/resource/r-0034.html

Hurtado, A., Escudero, E., Pando, J., Sharma, S., & Johnson, R. J. (2012). Cardiovascular and renal effects of chronic exposure to high altitude. Nephrology Dialysis Transplantation, 27(Suppl 4), Iv11-Iv16. doi:10.1093/ndt/gfs427

J. Q. (n.d.). High elevation may be linked to visitor heart attach deaths. Summit Daily, pp. 1-4.

Concussions and Altitude

With the number of concussions on the rise it is important to have an understanding of the occurrence of concussions as well as the management of concussions at higher elevations. Although the incidence of concussions is on the rise everywhere, high school athletes playing at higher elevations may actually be less likely to sustain a concussion when compared to athletes playing the same sports at sea level.

The Cincinnati Children’s Hospital conducted a research study examining the relationship between concussions and altitude among NFL athletes. The results of the study demonstrated a 30% decrease in the incidence of concussions in athletes playing at higher elevations (greater than or equal to 644 ft above sea level) (Myer et al., 2014). While there is no definitive explanation for this it is believed to be linked to the physiological changes of the brain at altitude. Concussions are typically caused from the rapid acceleration/ deceleration of the brain inside the skull. The hypothesis is that at higher elevations the brain tends to swell due to a mild increase in intracranial volume creating a tighter fit of the brain in the skull, leading to less damage caused by sheer forces (Myer et al., 4014).

While concussions may not be as common at elevation they are still occurring more than ever with detrimental long term effects if not recognized and treated properly. One thing we can do to recognize and treat concussions is to complete an ImPACT test. ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) is a computerized neurocognitive test which helps to assess neurologic changes after a concussion and helps guide recovery (Glendenning, 2017). The idea behind ImPACT is for individuals to have a baseline test, prior to any head injury/ concussion, and if a traumatic brain injury occurs, that individual would then undergo a post-concussion test, comparing the results to their baseline.  This helps better determine when it is safe for that individual to return to play without sustaining further injuries to their brain.

With the active lifestyle of children and adults in living at high altitudes, ImPACT testing may be just another step to consider when getting your bike tuned up for bike season, or your skis ready for a weekend on the slopes. Even if you aren’t a competitive athlete on a designated team, anyone at risk of hitting their head is at risk of suffering a concussion and would benefit from completing a baseline ImPACT test. ImPACT testing is available for only $15 at Avalanche Physical Therapy and takes only 30 minutes to complete (Glendenning, 2017). By being pro-active now you can help ensure a safer and healthier recovery in the future.

Schedule your baseline ImPACT testing at Avalanche Physical Therapy today!

www.avalanchetherapy.com

Betsy Metz, PA-S

Physician Assistant Student

Red Rocks Community College

 

References

Glendenning, L. (2017, March 7). Cognitive testing tool used to assess traumatic brain injuries in Summit County. Summit Daily News, p. 5.

Myer, G. D., Smith, D., Barber Foss, K. D., Dicesare, C. A., Kiefer, A. W., Kushner, A. M., … & Khoury, J. C. (2014). Rates of concussion are lower in National Football League games played at higher altitudes. journal of orthopaedic & sports physical therapy, 44(3), 164-172.