Re: High altitude and aortic stenosis
- From: dudleybates <dudleybates@xxxxxxxxx>
- Date: Sat, 1 Nov 2008 02:01:41 -0700 (PDT)
On Nov 1, 12:01 am, Richard <sooperdoo...@xxxxxxx> wrote:
Well I'm just thinking, maybe I'm going overboard (please say so if
you think I am).. but my son has a VSD and so he's at a higher risk of
having a stroke. If his hemoglobin goes up from the higher elevation,
then he's at an even higher risk of stroke. Also his circulatory
system is a bit different than normal, due to a syndrome he has
(22q11.2 deletion). The whole idea of moving to a higher elevation is
seeming less attractive. But again maybe I'm just scrutinizing this
whole thing too much, after all its just 4500 ft?
As you say, after all it's just 4500 feet. And as I said, 4500 feet
is not considered truly high altitude ... except for cake mixes.
CONGENITAL HEART DISEASE -- Since altitude-induced hypoxia increases
pulmonary resistance and right-sided pressures, it can be expected
that right to left shunting will increase in patients with congenital
defects involving abnormal intracardiac communications, such as atrial
septal defects, ventricular septal defects, patent ductus arteriosus,
and partially corrected tetralogy of Fallot. The extent to which
arterial oxygen desaturation occurs will depend upon many factors
including the size of the communication, the baseline right-sided
pressures, and the extent of altitude induced pulmonary hypertension.
Little has been published about the consequences of altitude exposure
in such patients. One study has demonstrated higher pulmonary pressure
in children with atrial septal defects born at altitude as compared
with both those without such defects at altitude and those with
similar defects not at altitude [21]. Another study showed that
children with ventricular septal defects born in Denver have twice the
pulmonary vascular resistance of children born with such defects at
sea level [22].
In a retrospective review of pediatric records at Children’s Hospital
in Denver [ALTITUDE 5,431 ft], Durmowicz reported six cases of high
altitude pulmonary edema in children with Down’s syndrome and
congenital heart defects exposed to only moderate altitude [23].
Unfortunately the number of children at risk of such complications is
not known. In a prospective study of 1116 school children in the
People’s Republic of China, Miao and colleagues showed a high
prevalence of patent ductus arteriosus and atrial septal defect at
three high altitude sites, with a graded effect as altitude increased
[24].
Recommendations: Advice to the child or adult contemplating altitude
exposure must be individualized and based on the nature of the
congenital defect and expected stresses. Those most at risk are those
with intracardiac communications and the propensity to worsen right to
left shunting in the presence of elevated right-sided pressure.
Consultation with a pediatric or adult cardiologist specializing in
congenital defects should precede altitude exposure.
http://www.dartmouth.edu/~cardio/Providers/topics/misc/altitude.html
(As Dr. Chung as pointed out, there is a big difference between ASD
and VSD, and left-to-right shunting and right-to-left shunting).
Richard, altitude is not exactly a gradual thing that goes from sea
level straight up to us, so that at 4,500 feet you would be gasping
for air. You would likely never notice a thing. We in Colorado
Springs are actually at a very mild altitude (and higher than
Denver.) But when I moved here, I had to go through a two-day
acclimation period (NOT gasping for air, more a nausea thing), and it
took me a month to build up the extra hemoglobin I needed. The
International Olympic Committee is based five blocks from me here in
Springs http://www.olympic.org/uk/games/past/index_uk.asp?OLGT=2&OLGY=1956,
as is a huge training center for athletes of all sports. The reason?
All athletes train at altitude solely for the reason to build up that
extra hemoglobin in their blood. That way when they return to sea
level to compete, they have that extra "unit" of oxygen-rich
hemoglobin in their blood--the equivalent of having transfused an
extra unit of blood without cheating, before competition.
Now, when I go up to Cripple Creek (an old gold mining town, now
famous for their history, melodramas and casinos, and you can pick
lump turquoise up off the dirt roads ... I start gasping for breath.
Their elevation is 9,494 feet. Of course they have a nice population
in Cripple Creek, even though they spend much of the winter inundated
with snow. But they get acclimated to the elevation.
Truthfully there is much bigger gap between 4,500 feet and 6,200 feet,
much better than it looks like on paper. But you're going into this
with cardiac abnormalities. So you *must* be responsible and so what
you're already doing, and make sure there isn't a problem before
jumping into a potential problem. I wish more people would do that.
What's the bottom line? You would be best served by getting a second
informed opinion, and a third official opinion, before making
permanent plans. Get them in writing, through your insurance, if you
can. This is your son. You cannot scrutinize it too much. Kudos
for being thorough.
p.s., have you thought about taking a weekend to a moderate elevation
resort like Springs, Mammoth Lakes, or the like, and observing how
your son tolerates it? I realize your concerns are about cummulative
effects. But his acute reactions to altitude might be a small
predictor of how well he might handle altitude. (Nausea, racing
pulse, breathlessness.) You would of course want to aggressively
hydrate and take other high altitude precautions.
best, Helen
.
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