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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