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Had mechanical valve and taking sintrom. Developed altitude sickness. What are the medicines to be taken?

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Practicing since : 1998
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Good afternoon,
I have had a mechanical valve for 16 years (I am 37 now). I take Sintrom and I am in very good general health and physical condition. I am active, I enjoy long walks in the mountains though I avoid major physical exertion. My question relates to altitude sickness: i intend to go to Ecuador on holiday and will fly into the capital which is 3000 m high, then for a few days i will be on even higher altitudes though not higher than 3500 m. There are walks but not difficult ones, and always opportunities to rest. I have been on such altitudes before but never stayed for longer than a few hours so I don't know how i will react (in general i will great in the mountains but I walk no higher than 2500 m). Am I more likely than others, because of the heart problem, to develop the altitude sickness? Can i prevent it somehow medically? I wouldn't like to give up the trip just for fear of developing the sickness.

Another question, not for this trip but in general for travelling to other places: am I allowed to take preventive malaria medication when travelling and are there any specific medicines that people with my heart condition should or shouldn't take against malaria?
thanks in advance for your advice,
Best regards XXXXXXX
Posted Thu, 26 Sep 2013 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 18 hours later
Brief Answer:
Please see details.

Detailed Answer:
Respected Ma'm
1. A person with pulmonary artery hypertension (raised pressure in lung vessels), heart failure & propensity to cardiac rhythm disorder should avoid going to high altitude as they have more risk of developing complications. Since you have a valve replacement, all these things should be evaluated first. The other risk factors for this include "too rapid an ascent", "higher altitudes especially above 3000 meters", "sternuous physical activity".
2. Any one, young or old, fit or unfit, man or woman, even with previous exposure to such altitudes can develop altitude sickness. Hence there is an element of individual susceptibility too. However in your case depending upon the underlying condition of your heart and due to the sinotrom therapy it may be relatively difficult to manage, if occurred.
3. There are tests which can be done in laboratories simulating high altitude conditions by lowering oxygen tension but they are not frequently available and are not recommended by standard bodies as fool-proof measures.
4. There are a number of drugs which have been used as prevention and best documented out of these is "ACETAZOLAMIDE" . This drug should be started before the ascent.
5. Other preventive measures are "do not do much physical activity", "avoid ascending too fast", "do not ascend more than 400 meters between two nights", "do not ascend if you feel unwell, have headache, undue shortness of breath or difficulty in walking normally" .
6. In nutshell, you have to consult your cardiologist, get your self examined, undertake certain tests if required before a final permission can be given. You will have to take preventive drugs and still it may occur, so be very cautious.
7. Regarding antimalarials, it depends which antimalarial is chosen by your physician and then we have to look at its effects on heart and its interaction with acenocoumarol.
Hope this helps.
Feel free to discuss further.
Sukhvinder Singh
Above answer was peer-reviewed by
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