Afib and High Altitude

[Stressbaker]

Has anyone had problems going to high altitude with treated Afib? I live at a mile high but often visit an area that is closer to 10,000’ elevation. When I was not on any medication I was advised to not go to the higher altitude because of increased stroke risk. Now I am on Eliquis twice daily so I am wondering if it would be safe to visit the higher elevation? My current cardiologist says no contraindications for travel but I was wondering if anyone has any personal experience with this?

[BobD Volunteer]

Not personally but I would just point out that commercial airliners are pressurised down to 9000' and nobody has ever said don't fly.

[CDreamer]

Travel no problem but skiing in Colarado certainly was! But I got altitude sickness in Denver anyway before getting to the resort.

If you are acclimatised you shouldn’t have Problems but couldn’t comment on increased stroke risk so you should be advised by your cardiologist. Do you know your QRisk score?

I then found I couldn’t do much over 1500m in Europe without high HR, fatigue which would trigger AF - but I also had low BP and anemia so probably not the best person to comment.

[Desanthony in reply to CDreamer]

Yeah Denver and Colorado gave me altitude sickness too - didn’t being on AF though. Went there years before AF reared it’s ugly head. Haven’t been to altitude since due to knee op and then Covid but cardio and EP both say I could go. Think I would stay to lower altitudes.

[Stressbaker in reply to CDreamer]

What is Qrisk score?

[CDreamer in reply to Stressbaker]

Algorithm to assess your individual risk of heart attack or stroke in the next 10 years for those up to the age of 84 against that of the general population - qrisk.org/

Often if your score is above the population average you will be advised to take statins.

It takes into account different factors to the CHADSVASC score such as cholesterol ratio and is used by many doctors, especially in General Practice to assess the type of monitoring patients need. I currently score 22% but if it wasn’t for AF I would be population average.

[secondtry]

I used to ski regularly in St Anton, Austria. Conclusion: Medium/ high altitude exacerbated by exertion brings on AF. Worst episode walking up a steep road to a mountain restaurant in the evening; late afternoon/evenings have always been a time for me to be extra careful.

[secondtry in reply to secondtry]

PS I think cold air is also a contributory factor to AF, worst when breathing a lot through your mouth. A cold drink is one of my triggers.

[Auriculaire in reply to secondtry]

I went into afib once just leaning out of the window and breathing in cold air for a few seconds!

[secondtry in reply to Auriculaire]

Yep, I did it by taking a few gulps of fridge cold ginger beer!

[Kent2007]

Hi Stressbaker. I've wrestled with the same dilemma, as I am (was?) a mountaineer and have been to 6000m when younger and before AF. I have always acclimatised badly. I have come to the decision not to go high again. The body's reaction to high altitude/low oxygen levels is to create more red blood cells. This is usually called blood thickening. I do not know whether this means it becomes more viscous, or whether it means blood will clot more readily (clotting is effected by platelets, not red blood cells). But, the extra effort of simply breathing, coupled with the effort of climbing means my chances of going onto AF would be much too high to be worth it. Easy decision for me, age 66 and living at 250ft ASL.

[DevonHubby1]

My wife suffers PAF and we took a cable car up Mount Tidje in Tenerife. At the top she struggled for breath, felt very light headed and we came down immediately at which point she improved. As far as my wife could tell by feel alone, she was not in AF before or after the ascent. She discussed this with her GP on return home and was advisrd to avoid going to high places in future so Macho Picho is off the bucket list now.

[DKBX]

More often than not, altitude sickness (AS) is due to dehydration. The air here in ABQ is extremely dry so visitors often complain about AS (head-aches, breathing issues, etc) at our mile-high elevation. When they drink MUCH more water (and ONLY water), learn to breathe only through their noses DEEPLY (yoga breath techniques) … all becomes well. Good luck.

[theohappy]

I'm hoping to go to Vail, CO, for several days in June. Husband is in an art show there. But also concerned about the 8,000 ft. elevation. Not sure how I will do. Going to ask the doctor when I see him next. We used to live in CO at 7200 ft elevation. I was so healthy there. Sometimes wonder if we had stayed if I would ever have gotten AFib.

[milehighlinnie]

Hello Stressbaker,

I am from the Denver area but have been in Texas for the past 2 years. Because I had been at sea level and no longer acclimated to the altitude, I did experience AFIB in Blackhawk, 8500 ft. I had no idea that could happen, and I would not have thought about it anyway as I guess I thought I would always be OK at altitude. I had very infrequent events anyway, but the altitude change did it for me. We had stayed the night and apparently nighttime makes it more likely.

I have since had an ablation and have had no more AFIB events. When I returned to CO, I stayed at approximately 5500 ft for 3 days before we went to Blackhawk. The first thing I did when I arrived in CO was purchase canned Boost Oxygen from Walgreens along with a lot of bottled water. I used the oxygen cans the entire time I was there to keep my heart rate from increasing which will always happen when you are not acclimated to altitude. I drank lots and lots of water and had no caffeine of alcohol. I also kept the pill in the pocket (metoprolol) and took ½ after arriving in Blackhawk as I felt my heartrate was increasing a bit. I also took extra magnesium. I did fine by doing all those things. We did not spend the night, but I think I would have been fine if we had.

Because you are already acclimated to 5280 you shouldn’t have a big problem, especially if you do all of those things and keep a pill in the pocket just in case. I found in reading about it that ideally, it is best to not overnight more than around a 1500 ft increase in altitude per day. That makes sense but it is not always easy to do. Again, because you are already acclimated to 5280, you should have a much easier time of it.

I just thought I would share my experience. Lots of water, magnesium, pill in the pocket and boost oxygen worked great for me. It helps to stay ahead of it. Have a wonderful time.

[Stressbaker in reply to milehighlinnie]

I really appreciate your input!