Martina Navratilova Hospitalized with high altitude sickness

In April of this year, we reported that Martina Navratilova had been treated for breast cancer. Earlier this month, she announced that she would be joining 26 other climbers in a goal to climb to the top of Mt. Kilimanjaro in Tanzania to raise money for Laureus Sport for Good Foundation charity, a group who hopes to use the power of sport as a tool for social change in Africa. The group started the their trek on December 8th, however Navratilova suspended her attempt after feeling poorly on the fourth day of the ascent. She was flown to Nairobi Hospital, which showed she was suffering from high altitude pulmonary edema (sometimes called HAPE)– an accumulation of fluid in the lungs. Dr David Silverstein, cardiologist and internist at the hospital, said, “Basically this is fluid in the lungs related to high altitude. It is potentially dangerous when someone is at high altitude, but once brought down, recovery is quick. Martina is doing well and will continue to do well.”

According to her website, Martina is in good spirits. “I’m disappointed not to be able to complete this amazing journey. It was something that I have wanted to do for so long, but it was not to be. I will be watching and waiting for news from the climb as they reach the summit tomorrow (December 11). Overall, I think the expedition has been a great success as we have raised funds and awareness for the work that Laureus does.”

Acute Mountain Sickness (Source: Medline Plus and CDC)

Acute mountain sickness is an illness that can affect mountain climbers, hikers, skiers, or travelers at high altitude (typically above 8,000 feet or 2,400 meters). It is brought on by the combination of reduced air pressure and lower oxygen concentration that occur at high altitudes. Symptoms can range from mild to life-threatening, and can affect the nervous system, lungs, muscles, and heart.

In most cases the symptoms are mild. In severe cases fluid collects in the lungs (pulmonary edema). The extra fluid can “drown” the patient by impairing the normal gas exchange with the circulating blood and can cause respiratory failure. This further reduces how much oxygen enters the bloodstream and reaches vital organs and tissue. Symptoms include extreme shortness of breath, a feeling of suffocating or drowning, frothy, possibly blood-tinged sputum, paleness, and excessive sweating. Brain swelling may also occur (cerebral edema). This can cause confusion, coma, and, if untreated, death.

The chance of getting acute mountain sickness increases the faster a person climbs to a high altitude. How severe the symptoms are also depends on this factor, as well as how hard the person pushes (exerts) himself or herself. People who normally live at or near sea level are more prone to acute mountain sickness.

Approximately 20% of people will develop mild symptoms at altitudes between 6,300 to 9,700 feet, but pulmonary and cerebral edema are extremely rare at these heights. However, above 14,000 feet, a majority of people will experience at least mild symptoms. Some people who stay at this height can develop pulmonary or cerebral edema.

Symptoms generally associated with mild to moderate altitude illness include:

• Difficulty sleeping
• Dizziness or light-headedness
• Fatigue
• Headache
• Loss of appetite
• Nausea or vomiting
• Rapid pulse (heart rate)
• Shortness of breath with exertion

Symptoms generally associated with more severe altitude illness include:

• Bluish discoloration of the skin (cyanosis)
• Chest tightness or congestion
• Confusion
• Cough
• Coughing up blood
• Decreased consciousness or withdrawal from social interaction
• Gray or pale complexion
• Inability to walk in a straight line, or to walk at all
• Shortness of breath at rest

Treatment:

The main form of treatment for all forms of mountain sickness is to climb down (descend) to a lower altitude as rapidly and safely as possible. Extra oxygen should be given, if available.

Acetazolamide (Diamox) is a drug used to stimulate breathing and reduce mild symptoms of mountain sickness. This drug can cause increased urination. When taking this medication, make sure you drink plenty of fluids and do not drink alcohol.

Pulmonary edema, the build-up of fluid in the lungs, is treated with oxygen, the high blood pressure medicine nifedipine or phosphodiesterase inhibitors (sildenafil), and, in severe cases, a breathing machine (respirator).

The steroid drug dexamethasone (Decadron) may help reduce swelling in the brain (cerebral edema).

Portable hyperbaric chambers have been developed to allow hikers to simulate their conditions at lower altitudes without moving from their location on the mountain. These new devices are very important if bad weather or other factors make climbing down the mountain impossible.

Tips for acclimatization to high altitude destinations.

• Ascend gradually, if possible. Try not to go directly from low altitude to >9,000 ft (2,750 m) sleeping altitude in one day.
• Consider using acetazolamide (Diamox) to speed acclimatization if abrupt ascent is unavoidable.
• Avoid alcohol for the first 48 hours.
• Participate in only mild exercise for the first 48 hours.
• Having a high-altitude exposure at >9,000 ft (2,750 m), for 2 nights or more within 30 days prior to the trip is useful.
• Treat an altitude headache with simple analgesics.

For more information, click here to go to the Resounding Health Casebook on the topic.