The electrocardiogram at extreme altitude: Experience on Mt. Everest

Karliner, Joel S.; Sarnquist, Frank F.; Graber, David J.; Peters, Richard M.; West, John B.

doi:10.1016/0002-8703(85)90555-1

Cited by 42 publications

(18 citation statements)

References 10 publications

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“…[10][11][12][13][14] In addition, the amplitude of T waves decreases or even reverses in precordial leads, mainly in V 1 and V 2 at rest. [15][16][17][18][19] However, the effects of exercise on ECG under hypoxia have been less documented, with most data coming from Operation Everest II in 1986.…”

Section: Clinical Perspective On P 794mentioning

confidence: 99%

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Electrocardiographic Changes During Exercise in Acute Hypoxia and Susceptibility to Severe High-Altitude Illnesses

et al. 2015

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Background-The goals of this study were to compare ECG at moderate exercise in normoxia and hypoxia at the same heart rate, to provide evidence of independent predictors of hypoxia-induced ECG changes, and to evaluate ECG risk factors of severe high-altitude illness. Methods and Results-A total of 456 subjects performed a 20-minute hypoxia exercise test with continuous recording of ECG and physiological measurements before a sojourn above 4000 m. Hypoxia did not induce any conduction disorder, arrhythmias, or change in QRS axis. The amplitude of the P wave in V 1 was lower in hypoxia than in normoxia. The amplitudes of the R, S, and T waves and the Sokolow index decreased in hypoxia. Under hypoxia, the amplitude of the ST segment decreased in II and V 6 and increased in V 1 , the ST slope rose in V 5 and V 6 , and the J point was lower in II, V 5 , and V 6 . Multivariate regression of hypoxic/normoxic ratios of electrophysiological parameters and clinical characteristics showed a correlation between the decrease in Sokolow index and T-wave amplitude in V 5 with desaturation at exercise. Trained status and low body mass index were associated with a smaller decrease in T-wave amplitude in V 5 and V 6 .Comparison of ECG between subjects suffering or not suffering from severe high-altitude illness failed to show any difference. Conclusions-During

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Section: Clinical Perspective On P 794mentioning

confidence: 99%

“…12,14,15 Concerning the incidence of cardiac diseases in the general population exposed to moderate or high altitude for sports or leisure activities, conflicting data are reported. In the mountains, 10% to 30% of deaths are sudden deaths.…”

Section: Clinical Perspective On P 794mentioning

confidence: 99%

Electrocardiographic Changes During Exercise in Acute Hypoxia and Susceptibility to Severe High-Altitude Illnesses

et al. 2015

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“…In contrast, much less known aspect of pressure overload of RV is its impact on electrocardiographic (ECG) changes. ECG findings consistent with pulmonary hypertension and RV ischemia and strain, including complete and incomplete right bundle branch block (RBBB), ST-segment changes and T-wave inversions, the S1Q3T3 pattern, and nonsinus rhythm, had been observed more frequently in patients with RV pressure load (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Role of electrocardiographic changes in discriminating acute or chronic right ventricular pressure overload

Can¹,

Özveren²,

Biteker³

et al. 2013

Anadolu Kardiyol Derg

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Objective: Pulmonary embolism (PE) and severe pulmonary stenosis (PS) are two distinct conditions accompanied by increased pressure load of the right ventricle (RV). Despite major advances in our understanding of the mechanisms of RV adaptation to the increased pressure, substantial gaps in our knowledge remain unsettled. One of much less known aspect of pressure overload of RV is its impact on electrocardiographic (ECG) changes. In this study, we aimed to study whether acute and chronic RV overload are accompanied by different ECG patterns. Methods: Thirty-eight patients with PE underwent ECG monitoring were compared with 20 matched patients with PS in this observational retrospective study. ECG abnormalities suggestive of RV overload were recorded and analyzed in both groups. Logistic regression analysis was used to define the predictors of chronic RV overload. Results: Among the ECG changes studied, premature atrial contraction (OR-12.2, 95% CI, 1.3-107, p=0.008), right axis deviation (OR-20.4, 95% CI 4.2-98, p<0.001), indeterminate axis (OR-0.11, 95% CI 0.02-0.44, p=0.001 0.11), incomplete right bundle branch block (OR-4.2, 95% CI, 1.1-15.4, p=0.02), late R in aVR (OR-8.4, 95% CI 2.1-33.2, p=0.001), qR in V1 lead (OR-8.3, 95% CI 1.2-74.8, p=0.03) were found to be the independent predictors of chronic RV pressure overload. Conclusion: Our data indicate that the ECG changes that attributed to the acute RV pressure loading states may be more prevalent in chronic RV overload as compared with acute RV overload. (Anadolu Kardiyol Derg 2013; 13: 344-9) Key words: Right ventricular pressure load, electrocardiography, disease process, regression analysis Original Investigation Özgün Araşt›rma 344ÖZET Amaç: Sağ ventrikül (SV) fonksiyonu birçok kardiyopulmoner hastalıklarda klinik sonlanım olarak önemli rol oynar. Pulmoner emboli (PE) ve ciddi pulmoner darlık (PD) SV basınç yüklenmesi ile seyreden iki ayrı hastalıktır. SV' nin artmış basınç yüklenmesine karşı verdiği uyum mekanizmaları iyi bilinmesine karşın hala bazı tanımlanmamış boşluklar devam etmektedir. SV basınç yüklenmesinin elektrokardiyografik (EKG) olarak nasıl bir deği-şiklik yaptığı pek bilinmemektedir. Çalışmamızdaki amaç akut ve kronik basınç yüklenmesini EKG olarak ayrımının yapılabileceğini araştırmaktır. Yöntemler: Bu retrospektif gözlemsel çalışmamıza 20 PD ve 38 PE tanısı kesinleşmiş hasta dahil edildi. SV yüklenmesini gösterdiği daha önceki çalışmalarda kabul edilmiş EKG kriterleri her iki grupta araştırıldı. Logistic regression analysis was used to define the predictors of chronic RV overload. Bulgular: Bakılan EKG değişikliklerinden, prematür atriyal atım (OR-12.2, %95 CI, 1.3-107, p=0.008), sağ aks deviasyonu (95)(96)(97)(98) p=0.001), indetermine aks (OR-0.11, %95 CI 0.02-0.44, p=0.001), inkomplet sağ dal bloğu (OR-4.2, %95 CI, 1.1-15.4, p=0.02), aVR de geç R dalgası (OR-8.3, %95 CI 1.2-74.8, OR-8.4, %95 CI 2.1-33.2 p=0.001), V1' de qR dalgası (OR-8.3, %95 CI 1.2-74.8 p=0.02) SV kronik basınç yüklenmesini gös-teren bağımsız prediktörle...

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“…It is unclear whether the presence of late potentials in asymptomatic individuals without evident structural heart disease has prognostic implications. Hypoxia determines various but limited electrocardiogram (ECG) abnormalities at extreme altitudes in normal subjects' 15 " 171 . However, ECG occasionally show premature ventricular beats in healthy subjects in these conditions' 171 .…”

Section: Introductionmentioning

confidence: 99%

Effects of exposure to hypoxia on the signal-averaged electrocardiogram in healthy subjects

Roche¹,

Barthélemy²,

Adamec³

et al. 1995

European Heart Journal

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The electrocardiogram at extreme altitude: Experience on Mt. Everest

Cited by 42 publications

References 10 publications

Electrocardiographic Changes During Exercise in Acute Hypoxia and Susceptibility to Severe High-Altitude Illnesses

Electrocardiographic Changes During Exercise in Acute Hypoxia and Susceptibility to Severe High-Altitude Illnesses

Role of electrocardiographic changes in discriminating acute or chronic right ventricular pressure overload

Effects of exposure to hypoxia on the signal-averaged electrocardiogram in healthy subjects

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