Going to High Altitude with Heart Disease

As a result of ease of travel, a rising number of individuals, including many patients with pre-existing cardiovascular disease, visit high-altitude locations (>2500 m). Exposure to high altitude triggers a series of physiological responses intended to maintain adequate tissue oxygenation. Even in healthy subjects, there is enormous interindividual variability in these responses, which may be further amplified by environmental factors. These adaptive mechanisms may cause major problems in patients with pre-existing cardiovascular disease who are not able to compensate for such physiological changes. Pre-exposure assessment of patients helps to reduce risk and detect contraindications to high-altitude exposure. The great variability and unpredictability of the adaptive response should encourage physicians counselling such patients to adopt a cautious approach. Here, we briefly review how high-altitude adjustments may interfere with and aggravate/decompensate pre-existing cardiovascular diseases. Moreover, we provide practical recommendations on how to investigate and counsel patients with cardiovascular disease desiring to travel to high-altitude locations.