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High Altitude And Hcm

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  • Burton Borrok
    replied
    Re: High Altitude And Hcm

    Well, I guess we pretty well exhausted the high altitude airline travel atmosphere. Anybody feel like attacking submarine travel and sandhog digging? Sandhog’s, I think you know are the men who dig tunnels under rivers and straights (like the Chunnel between England and France.) They work in a pressurized environment to keep the water from seeping into their work area until the new walls can be installed.

    I assume we can throw in the deep submersible drivers and diving bell operators along with scuba and deep sea divers on oxygen rich breathing apparatuses. Not only does the nitrogen dissolve into their blood, they are over oxygenated also. What does this do to undiagnosed HCM’ers or others with undiagnosed heart and/or lung problems? What is it like for people on the other side of this coin?
    Burt

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  • mtlieb
    replied
    Re: High Altitude And Hcm

    Rhoda,

    Didn't mean to sound discouraging with my posts... i just found the whole airline/altitude topic pretty fascinating and went a little crazy looking up information about it, that's all. I enjoy doing research, and had a lot of fun actually looking up all those little facts. You've obviously done a lot of flying with no trouble at all, so i wouldn't give any of this a second thought

    Have a safe journey! If i remember correctly, you are coming back to the states and will be seeing your doctors here?

    Jim

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  • Reenie
    replied
    Re: High Altitude And Hcm

    Rhoda, if it makes you feel better, my husband flew over the Pacific at least 4 times (roundtrip) after he found out he had HCM, 3 of those with his ICD, and he had absolutely no problems at all.

    Reenie

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  • Laoshur
    replied
    Re: High Altitude And Hcm

    Man, you guys sure do know how to discourage a person right before she flies pretty near exactly half-way around the world!

    Rhoda

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  • mtlieb
    replied
    Re: High Altitude And Hcm

    Originally posted by Reenie
    Also, the bags of chips puff right up at less pressurization.
    Apparently, so does the air in your chest... yikes!

    "Coronary artery bypass grafting and other chest surgeries should pose no intrinsic risk as long as the patient has fully recovered without complications. However, because air is transiently introduced into the chest cavity, there is a risk for barotrauma at decreased atmospheric pressure (at 8000 ft, trapped gas will expand 25%). Consequently, patients should wait until the air is resorbed (about 10-14 days) before air travel. Clinical evaluation prior to air travel is important to ensure a stable postoperative course and to rule out CHF, serious arrhythmia, or residual ischemia."

    Medical Guidelines for Airline Travel, 2nd Edition
    Aerospace Medical Association
    Medical Guidelines Task Force
    Alexandria, VA

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  • Reenie
    replied
    Re: High Altitude And Hcm

    Sort of a by-line here, I've been on flights that were less pressurized (military cargo planes) and I've had my feet swell to where I needed to remove my shoes. Also, the bags of chips puff right up at less pressurization.

    Reenie

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  • mtlieb
    replied
    Re: High Altitude And Hcm

    Thanks Burt,

    I'm back in schoolwork mode trying to catch up on lost time here, so research is the name of the game for the rest of my recovery.

    I thought it was interesting to learn that commercial airlines are permitted to breach the 8000 ft cabin altitude mark short-term, for instance if the pilot makes a hasty maneuver to avoid a storm, turbulence, etc. One study i came upon noted cabin altitudes on several commercial airlines in excess of 9000 ft, although the average cabin altitude across all commercial airlines was reported to be between 6000 and 8000 ft in that study. As a footnote here, oxygen masks are deployed at a cabin altitude of 12,000 ft.

    The term cabin altitude refers of course to the ground elevation equivalent that is being supplied by the airline's cabin pressurization. Given an average cabin altitude of 6000 to 8000 ft across the board, then on a typical domestic flight you are receiving between 20 and 25% less oxygen than if you were standing at or near sea level. It's no wonder some folks have problems. Of course if you live at an altitude of 6000 ft or greater already, you are effectively acclimated to airline travel and presumably would not suffer any distress.

    Good point about the alcohol as well. The dehydration factor is also of concern for HCM'ers, since the filtered and recycled air on an airplane is very dry and could certainly contribute to increased symptoms in-flight.

    Interesting topic!

    Jim

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  • Burton Borrok
    replied
    Re: High Altitude And Hcm

    Hi Jim,
    It’s real good to see your brain in full working order. By golly, you sure do heal quickly.

    As I mentioned earlier, my friend flies with three oxygen bottles, yet at ground level does just fine only using oxygen when she sleeps. The operating costs verses passenger comfort is of significant concern to the airlines, and that’s why some airlines set their cabin pressure at different levels then others – at least they used to.

    Since 9/11 and the squeeze on the airline dollar, they may all have set the level at 8,000 feet, or at least claim that percentage of pressure. It still may be worth a few 800 number calls to see where things have gotten to these days. Cabin pressure for some is of more significance then for others, and they might just as well fly in comfort, if possible.

    By the way, some of the other effects, - you get drunk easier and quicker. Some people may feel fine while sitting in their seats, but get woozy when getting up to go to the john, and some even have a marked change in their personalities. It’s a wonderful world.
    Burt

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  • mtlieb
    replied
    Re: High Altitude And Hcm

    All good points, Burton.

    Even if we assume that every commercial airline operates within federal guidelines... cabin pressurization is derived from the jet engines, and higher cabin pressures result in a significant increase in fuel demand. The airlines aren't likely to spend that fuel frivolously. I'm sure they try to achieve the minimum amount of cabin pressure possible to maintain passenger comfort, while at the same time conserving fuel and reducing operating cost.

    I assume the following information regarding air travel would also apply to ground travel at altitudes above 8000 feet:

    "Hypobaric hypoxia (hypoxia due to a lowered oxygen pressure at altitude) is a major concern for airline travelers with cardiovascular disease. At a cabin altitude of 8000 ft, the inspired partial pressure of oxygen is 108 mm Hg (versus 149 mm Hg at sea level). This correlates with a PaO2 (arterial O2 pressure) of 50-60 mm Hg in people with normal baseline PaO2. If these last data are plotted on the oxyhemoglobin dissociation curve, we obtain a blood oxygen saturation of 90%. Although most healthy travelers can normally compensate for this amount of hypoxemia, this may not be true for coronary, pulmonary, cerebrovascular, and anemic patients. Because these patients may already have a reduced PaO2 on the ground, further reduction in aircraft cabin pressure will bring them to the steep part of the oxyhemoglobin dissociation curve with a resultant very low saturation, which could cause distress and/or exacerbation of their illness.

    Cardiac patients compensate to some extent for inflight hypoxia by increasing minute ventilation, mainly by increasing tidal volume. The primary cardiac response to hypoxia is mild tachycardia, which results in increased myocardial oxygen demand. In patients with limited cardiac reserve, the decreased oxygen supply at altitude and resultant tachycardia may result in symptoms and cardiac decompensation. Consequently, in some cases, medical oxygen may be required.

    The managing physician must be mindful that the excitement and stress of air travel can further precipitate symptoms in individuals with limited reserve.

    Severe decompensated congestive heart failure (CHF) is a contraindication to air travel. However, in stable CHF, inflight medical oxygen is advisable for patients with New York Heart Association (NYHA) class III-IV CHF or baseline PaO2 less than 70 mm Hg."

    Medical Guidelines for Airline Travel, 2nd Edition
    Aerospace Medical Association
    Medical Guidelines Task Force
    Alexandria, VA

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  • Burton Borrok
    replied
    Re: High Altitude And Hcm

    I do believe many airlines do not even approach an in-cabin air pressure equivalent to 8,000 feet, as too many of the passengers are discomforted, and that’s just not good for business.

    If altitude bothers you, and there are a number of airlines to choose from, call them and ask what they keep their cabin pressure at in flight, then choose the airline that maintains the lowest altitude equivalent.

    Frankly, I haven’t done that in years – goes back to when I flew every week – but I believe they still have such variations. At least it’s worth checking out.

    I have a friend that flies between California and New York. She pays $75 over the ticket for three bottles of oxygen on board, whether she uses them or not. The last time she flew she asked if they had three bottles on board, and the stewardess said they had two. My friend said, I paid for three and you WILL have three! They scrambled around and got the third bottle. If she hadn’t been aware and insisted, they would have flown with two. You have rights as a passenger, make sure your needs are met.
    Burt

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  • mtlieb
    replied
    Re: High Altitude And Hcm

    Since even healthy, normal-hearted people can experience symptoms of altitude sickness due to decreased oxygen levels, one would have to assume that for those HCM'ers who normally experience shortness of breath anyway, symptoms would be exacerbated.

    In Denver, for instance, which is at an elevation of approximately 5,280 feet, there is 17% less oxygen in the air than at sea level. At 8000 feet the amount of available oxygen is 25% less than at sea level. About 25% of unacclimated people develop symptoms of altitude sickness at only 6000 feet. Symptoms include headache, fatigue, shortness of breath, and nausea. It takes 1 to 2 days for the average person to fully acclimatize to altitudes of up to 10,000 feet. More time is required for altitudes above that.

    Regarding air travel... by law, the cabin pressure of a commercial airline cannot be less, at maximum cruise altitude, than the equivalent of outside air pressure at 8,000 feet. That's still pretty thin air. Therefore, symptoms of altitude sickness can, and do occur during air travel. An air traveler also has no chance to acclimate... the ascent from sea level to 8000 feet (effectively) can take place in a matter of minutes. This could certainly explain why some HCM'ers experience increased symptoms in-flight.

    Well, that's my take on the discussion anyway

    Jim

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  • Darren1
    replied
    Re: High Altitude And Hcm

    I suspect that a correlation exists between anxiety and flying and that anxiety can often times be difficult to differentiate from heart/breathing/etc.. problems (since when we are anxious, those symptoms manifest themselves).

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  • Cappy
    replied
    Re: High Altitude And Hcm

    I have flown and I had no problems. Except there wasn't enough peanuts in the bag

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  • Laoshur
    replied
    Re: High Altitude And Hcm

    I suspect there still is a correlation. My husband, who has no known heart problems gets faint and vomits and all kinds of good stuff at high altitude. I had no problem with high altitudes, even though I was severely anemic, until about five years ago, after not being at high altitudes for about 6 years. I found that I was panting severely just walking slowly downhill. I was there for a meeting and was late for nearly every one. My husband concluded that I was still anemic, but I was not. So, what made the difference? I can't say for sure, but, although I had had some symptoms of HCM for many years, it was about ten years ago that things got bad enough that I was first sent to a cardiologist. So, I think there is at least a correlation between altitude problems and the severity of HCM symptoms.
    Rhoda

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  • Darren1
    replied
    Re: High Altitude And Hcm

    I have been in the mountains frequently above 10,000 feet. While there, I've had no problems or symptoms (even when skiing or doing other very aerobic activities. I was born in Boston and currently live in SD, California.. My wife was born and raised in Denver, she gets dizzy when at high altitudes! (and she has a "normal" heart"). Don't know if there is a correlation between probelms with Altitude and HCM.

    Leave a comment:

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