Transcript Staying and exercising in high altitude mountains

Staying and exercising in
high altitude mountains
Answers to questions asked by patients
Staying and exercising in high altitude mountains
The DRAWBACKS in HIGH ALTITUDE MOUNTAINS are:
• LACK OF OXYGEN
• PHYSICAL ACTIVITY
• CLIMATE CHANGE and FOOD
• ISOLATION
© Dr. Richard MONIN
Staying and exercising in high altitude mountains
Lack of oxygen leads to lung,
brain and kidney adaptation,
which
provokes
difficulty
breathing and headaches.
© Dr. Richard MONIN
Performance and high altitudes
High altitudes really start from
PERFORMANCE AND
HIGH ALTITUDES
3,500 m.
However,
performances
are
reduced by 1/3 at 2,500 m, and
by 80% above 6,000 m.
© Dr. Richard MONIN
Mountain sickness…
…corresponds to poor adaptation to high altitudes.
- Mild effects (most frequently): headaches; localized edema.
- Serious effects: 50% of deaths ; HACE (High-Altitude Cerebral
Edema); HAPE (High-Altitude Pulmonary Edema).
Any faintness OR symptoms due to high altitudes should be
considered as adaptation problems, unless proven otherwise.
© Dr. Richard MONIN
Symptoms of mountain sickness
Assessment score
Headaches,
insomnia, nausea
Headaches
despite
aspirine,
vomiting
Dyspnea at rest,
fatigue,
reduction in urine
production
= 1 point
= 2 points
= 3 points
What to do or take?
Score
AMS
(Acute
Mountain
Sickness)
What to do or
take?
1 to 3
Mild
Aspirine,
paracetamol
4 to 6
Moderate
Aspirine, rest,
stop
progression
6
Severe
Quickly go
down
© Dr. Richard MONIN
Staying in high-altitude mountains:
contraindications (> 3,500 m)
ABSOLUTE
RELATIVE
Epilepsy
Moderate hypertension
Psychiatric history
Diabetes, severe obesity
Lower limb arteriopathy
Stress asthma
Severe hypertension
Sleep apnea
Heart failure
Even heart disease
Respiratory failure
Pregnancy at 1 and 3 months
Pulmonary hypertension
Baby < 18 months
HACE or HAPE history
Contraceptive pill
© Dr. Richard MONIN
Acute Mountain Sickness: PREVENTION
BEFOREHAND:
COMPLY WITH contraindications.
DRINK a lot.
Take DIAMOX 250 mg/day for 24h, until
you reach the highest peak.
If patient has already undergone climate
change problems, SEE a DOCTOR.
After 45, you must TRAIN before any
physical activity.
IN THE MEANTIME: 3 golden rules!
1. Do not go too high too fast (maximal
difference in height: 400 m between each
night above 3,500 m).
2. Go high enough for adaptation and
acclimatization.
3. Do not stay too high too long.
© Dr. Richard MONIN
Acute Mountain Sickness: TREATMENT
- During the first symptoms, take NIFEDIPINE
20mg and CORTICOIDS: DEXA 4mg/8h.
- GO
DOWN following acceptable security
conditions.
- Give OXYGEN to patient, using portable
hyperbaric chamber (= 4kg).
Portable hyperbaric chamber
© Dr. Richard MONIN
What to do when a heart patient wants to go
to high altitude mountains?
FOR STABLE CORONARY PATIENTS:
• Wait for 6 months after stent or angioplasty.
• ASYMPTOMATIC (negative stress test): no contraindication.
• SYMPTOMATIC (positive stress test): maximum altitude: 2,500 m.
• In SUSPECTED PATIENT (high risk factor): stress test is required if exercise above
2,500m is planned.
FOR PATIENTS WITH HEART FAILURE: Maximum altitude = 1,500 m.
FOR VALVULAR PATIENTS: Do not exceed 2,500 m because of anticoagulants.
© Dr. Richard MONIN
High altitudes and drugs for cardiovascular
diseases
• TRINITRINE : be careful with sprays because of high altitude pressure. At
3,000, 1 spray = dose x 3  risk of hypotension.
• Anti-arrhythmic treatments: absolute contraindication.
• Anticoagulant treatments: do not go above 2,500 m.
• Contraceptive pill = increased risk of thromboembolism (contraindication
if pulmonary embolism history).
© Dr. Richard MONIN
Frequently asked questions…
• Is it possible for a pregnant woman to stay in high altitude mountains?
Avoid! Follow indications of progestogen-only pills.
• Can we go to high altitude mountains with our children?
Avoid high altitudes above 1,600 m if your child is under 24 months old.
• What are the risks with trips to mountains like the Mont Blanc?
Acute mountain sickness affects 1 person in 2. Take DIAMOX and drink a
lot to prevent it. And do not forget to use a suitable equipment with appropriate
clothes, shoes, spikes, ice axes, etc.
© Dr. Richard MONIN