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altitude a problem?

In the Fodor's Switzerland guidebook, it says "Adults with heart problems may want to avoid all excursions above 6,500 feet." I haven't read anything like that anywhere else. I do have heart problems (stage 1 HF) and would like advice from others concerning that caution.
First, does anyone have personal experience that confirms or refutes the warning? Second, is there a handy way to find out how high different destinations are?

Posted by
745 posts

According to the World Health Organzation..."Although aircraft cabins are pressurized, cabin air pressure at cruising altitude is lower than air pressure at sea level. At typical cruising altitudes in the range 11 000–12 200 m (36 000–40 000 feet), air pressure in the cabin is equivalent to the outside air pressure at 1800–2400 m (6000–8000 feet) above sea level."
Of course, inside the cabin, strenuous activities are not encouraged.

Posted by
6478 posts

I would talk to my doctor about how high altitudes might affect me, I probably wouldn't rely on anyone's personal experience. And, if you google your destinations you should be able to get an altitude from their website or wikipedia.

Posted by
311 posts

HI Bob
The higher you go, the less available oxygen. I believe that is why there would be a caution about excursions about 6500 feet. But I think it would be best to ask your doctor ( cardiologist preferably ) in terms of if this is a concern for you. Or if you just need to watch how much exercise you try to do at high elevations. I would think if you find yourself easily out of breath at sea level, that you would notice it more at 10000 feet, for example.

Posted by
31466 posts

Bob,

Could you provide some indication of which specific high altitude locations you'd like to visit in Switzerland? Some of the main attractions are.....

  • Schilthorn - ~10,000 feet
  • Jungfraujoch - ~12,000 feet
  • Mt. Pilatus (near Lucerne) - ~6,985 feet
  • Mt. Titlis - ~10,600 feet
  • Mt. Rigi - ~5,900 feet

I don't have any conditions that would prevent travel to those altitudes, and haven't noticed any problems at the Schilthorn. However at the Jungfraujoch, I experienced slight effects from the altitude such as more effort required in climbing stairs and things like that.

To assess your risk of travelling to locations at altitude with Stage 1 CHF, your best resource is your family doctor or cardiologist. I would most definitely suggest having a chat with them about this.

Posted by
5784 posts

A number of sources consider "High" altitude to be elevations in excess of 8000 ft asl. At 8000 feet, air pressure is about 10.9 psi, about 3/4th of standard pressure at sea level (14.7 psi). Air pressure at 6,500 ft is about 11.5 or 11.6 psi, slightly higher than the 8000 ft threshold. That said, our body gets less oxygen at 6,500 ft than at lower elevations.

Rather than "avoid all excursions" I would think that minimizing execution and listening to your body would be the smart thing after checking with your cardiologist. Consider minimizing time exposure at high elevations and sleep at lower elevations.

In preparation of consultation with your cardiologist, review the American College of Cardiology paper: https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2018/01/19/10/10/clinical-recommendations-for-high-altitude-exposure-of-individuals
David S. Bach, MD, FACC: "High Altitude Exposure Among People With Cardiovascular Conditions", Jan 19, 2018.

At high altitudes, considered those higher than 2500 m (~8200 ft)
above sea level, physiologic responses may start to represent
challenges for the human body. This article reviews available evidence
on the effects of high altitude among patients with cardiovascular
conditions, and the risks of developing clinical cardiovascular
events.

Posted by
427 posts

Thanks for the responses everyone.
Blue, that’s interesting about the air pressure in aircraft cabins. As you say, though, there’s not much hiking or stair-climbing inside the cabin.
Nancy, Lisa, Ken: I’m just collecting information. Of course my cardiologist’s opinion is important, but it won’t be the only source I will consider. Have you ever noticed that different doctors give different advice, even about mainstream medical questions? (treatments, dosages, etc.) I’m thinking that altitude-related questions aren’t all that mainstream for a Florida-based cardiologist, so I’m just seeing what other people may have encountered.
Edgar, thanks for that reference. Lots of good information.
Our likely itinerary is Zurich to Montreux via the Golden Pass route, with a possible side trip from Interlaken (that's where the highest altitude would come in).

Posted by
13053 posts

That Fodor's advice is very generic and may or may not apply to you.

But even a Florida-based cardiologist should be familiar with the risks, if there are any for you, that could be associated with altitude exposure.

That abstract linked by Edgar seems to say that in the case of heart failure, it is the "co-morbidities" such as COPD, kidney disease, anemia etc. , that may give rise to problems at altitude. Medications may also influence the reaction to altitude.

Note the sidebar link on safety precautions for heart patients:

https://www.cardiosmart.org/News-and-Events/2018/02/Safety-Precautions-for-Heart-Patients-Traveling-to-High-Altitudes?_ga=2.18759728.86403198.1577400997-460831863.1577400997

They mention only the risk to patients with "severe" heart failure, not Stage 1. If you look at various websites explaining medical conditions, cause and risks to laypersons, like Mayo Clinic, WebMed, etc., you will see that most will say that in Stage 1 HF there are no exertional or activity restrictions. I have looked at these myself as my husband has a diagnosis of mild HF but he doesn't let it slow him down; we do a lot of hiking at altitudes as high as 11,000 feet.

He is a doctor himself and monitors his response carefully, but also relies on his cardiologist for individualized recommendations specific to his condition and medication list. So should you.

I will note that none of the locations you list is as high as 6500 feet. Only if you go past Interlaken and well above Mürren ( itself at 1638 m or 5374 feet) would you reach that altitude.

Posted by
1556 posts

A lady on our tour of China and Tibet got into trouble once we reached Lhasa. She had to be taken to a clinic and then to lower elevation for treatment. She had to wait a week for all of us to finish our seven day visit in Tibet. She was on Diamox to help prevent altitude sickness, and it did not help her at all. She developed pulmonary edema. Apparently she had some cardiac issues. She was in her 60s.
I wouldn’t take any advice from anyone on this forum. Your cardiologist is the only one you should listen too!

Posted by
13053 posts

HAPE ( High Altitude Pulmonary Edema) or "altitude sickness" can strike anyone, with or without cardiac problems. But the altitude where it occurs is usually considerable higher than what we are talking about here (6500 feet or so). Lhasa is at nearly 12,000 feet.

But yes, Bob should discuss this with his cardiologist, who is the one who knows his medical history and medication list.

Posted by
427 posts

Thanks Diane. That's the kind of anecdotal evidence I was asking for.
I'm not trying to make this forum a substitute for medical advice from my cardiologist. I am just asking for peoples' travel experiences.

Posted by
1556 posts

OP

Yes, altitude sickness can happen to anyone. A case of Pulmonary edema wouldn’t be a good thing to happen to anyone with or without cardiac issues.
And Lhasa is higher but she became ill while we were heading up the hill so to speak.

Posted by
14885 posts

You can google any location - "what is the altitude of Zurich" for instance.

The problem would be if you want to go up to any of the peaks ("excursions"). Most towns are at relatively low altitude, but a cable car will whisk you up from 3000' to 10000' in a matter of minutes. Many people are susceptible to altitude sickness (dizziness, nausea . . . ) when there's a big change in altitude without a couple of days gradual ascent to allow the body to acclimate. The only remedy is to descend. That has nothing to do with heart problems however.

Posted by
5784 posts

To reiterate, this forum is not a expert medical forum and advice re your heart problem (what ever a "stage 1 HF" is) and altitude should come from your medical practitioner. That said, my awareness of altitude comes from my high Sierras backpacking days and cross country skiing at elevations above 5000'/6000' (our typical snowline).

Not knowing what a "stage 1 HF" is, my guess is that short duration tourist excursions (not strenuous activity, l.e. not mountaineering or skiing) above 6,500' are not a significant health risk. You may be making too much of the Fodor's CYA warning. Tourist excursions fall into the category of "play high sleep low". Dr. Peter Hackett, a medical practitioner wrote the The Mountaineers guide on high altitude sickness. His website has some thoughts on high altitude and pre-existing medical conditions: http://www.altitudemedicine.org/altitude-and-pre-existing-conditions

PREEXISTING MEDICAL CONDITIONS AT ALTITUDE

Many people with specific health issues can travel safely to altitude.

HEART DISEASE (CORONARY ARTERY DISEASE)

Altitude creates some stress on the heart, which is minimal at rest
but can be significant during exercise. Cold in combination with the
altitude and exertion may produce even more strain on the heart.
Nevertheless, a few surveys done at moderate altitude showed that
persons with underlying heart disease tolerated altitude quite well.

Patients with coronary artery disease will likely do well at moderate
altitude of ski resorts if they follow a few guidelines: [See link for
list]

ARRHYTHMIAS

PVCs or premature ventricular contractions occur frequently at
altitude. The heart basically throws an extra beat every so often and
while they are quite harmless they can be uncomfortable. Increasing
levels of stress hormones in the body upon arrival to altitude are
likely the cause for these additional beats. Avoidance of caffeine may
help.

HEART FAILURE

Heart failure (HF) has not been studied extensively at altitude.
Persons with HF have increased sensitivity to fluid retention. Since
retaining fluid at altitude occurs frequently with or without AMS,
this could potentially cause a worsening of heart function. Patients
with HF, if they are careful, can likely travel to moderate altitudes
safely. Below are suggested recommendations: [See web lini for list]

DR. PETER HACKETT
Dr. Peter Hackett is a world renowned high altitude expert and altitude research pioneer. He is a leading authority on altitude illness, high altitude climbing, wilderness medicine, and the effects of altitude on people living and working in the mountains. Dr. Hackett is also a board certified Emergency Physician. Dr. Hackett has been at the frontier on altitude research, with years of experience in the Himalayas, Denal i, South America and in Colorado. Dr. Hackett has authored more than one hundred articles on altitude issues, has edited six books and is respected internationally for his expertise.

Posted by
901 posts

I personally get altitude sickness above 8,000 feet. Mürren was around 5,800 feet and I had zero problems there. It looks like you are super high up but you aren’t.

Posted by
13053 posts

Edgar, "HF" is short for "heart failure" and Stage 1 is the mildest form. In simplest terms, it means the heart is not pumping efficiently.

According to the more recent article you quoted, altitude is unlikely to cause a risk for someone with low-grade heart failure. However, he may have other complicating issues or medications that exacerbate the effect of altitude. That is why it is essential he consult his cardiologist, as you and I and nearly everyone else has advised,

Note that this heart condition is entirely separate from the issue of "altitude sickness" which others have mentioned.

And like Edgar, I believe that Fodor's caution is simple CYA.

Posted by
427 posts

Thanks everyone. Any confusion about my consulting my doctor is probably my fault due to the way I worded my initial post. Of course I will talk with my cardiologist(s).
I actually have two different cardiologists (separated by some distance) and they do not always agree on treatment. As much as I respect the medical profession, one cannot expect doctors to be all-knowing or infallible. More than once, I have had doctors ridicule treatments that were considered state-of-the-art by other specialists in the same field.
I wanted additional information from travelers and that is what you've given me. Thanks again.

Posted by
3681 posts

That's why they call it "practicing" medicine.

Posted by
31466 posts

Bob,

It's great to hear that you've got this all sorted. Have a wonderful time in Switzerland!

Posted by
16 posts

Just my two cents. I have had issues with altitude above 8,000 feet (headache, vague nausea - nothing dramatic) and I have no heart conditions. I'm fine again as soon as we get below 8,000 feet. It seems to be an individual thing since the same heights have no effect on my husband at all. We're headed for Switzerland this spring and I don't plan on being able to eat the nice breakfast buffet at Piz Gloria. I've also selected either level or downhill hiking routes that start below 6,000 for that reason.

Posted by
77 posts

I agree with the above. In September I did some hiking in the Berner Oberland around Lauterbrunnen and Grindelwald. The hike I took with the highest elevation was the Eiger Trail which started at 7500 feet from Eigergletscher Station. I definitely noticed the thinness of the air and an increased tendency to be winded on the hike -- compared to the other hikes I took that were all at lower altitudes. I'm 70 years old but no heart problems or other health issues.