Can my patient with CVD travel to high altitude?

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.

Validation of noncompaction criteria in dilated cardiomyopathy, and valvular and hypertensive heart disease.

BACKGROUND: Echocardiographic characteristics typical of isolated left ventricular noncompaction (IVNC) have been well defined. The aim of this study was to validate diagnostic criteria of IVNC in valvular or hypertensive heart disease (HHD) or dilated cardiomyopathy. METHODS: We conducted a retrospective analysis of records and blind review of videotapes of all 19 patients with IVNC seen within 7 years in comparison with randomly selected patients from the same study period with dilated cardiomyopathy (31 patients), HHD (22 patients), and chronic severe valvular heart disease: mitral regurgitation (22 patients); aortic regurgitation (20); and aortic stenosis with bicuspid (22) or tricuspid (22) valves. RESULTS: Clinical characteristics and electrocardiographic findings did not differ between IVNC and other diseases. In IVNC, all patients had noncompacted (NC) segments with a 2-layered structure and wall thickening, and in most patients perfused recesses (95%) or hypokinetic segments (89%) were present. Both hypertrabeculation or presence of a meshwork were specific for IVNC, but the sensitivity for IVNC was only 11% for hypertrabeculation, respectively, 68% for meshwork. In dilated cardiomyopathy, perfused recesses (48%) and a 2-layered structure (26%) were seen but without wall thickening of these segments; all NC criteria including wall thickening were fulfilled in one patient (3%) only. In valvular heart disease or HHD, perfused recesses and a 2-layered myocardium were rare: two patients (5%) with aortic stenosis and one patient with HHD (5%) had NC. Although in IVNC wall thickening was confined to the 2-layered myocardial segments, it was diffuse in other diseases. CONCLUSIONS: Although some NC criteria are occasionally found in other heart disease, the combination of all criteria is very specific. All criteria of NC are rarely met in other disease than IVNC (< or = 5%).