1
|
Chaudhry WAR, Ahmad BA, Waqas MS, Khan JR, Khan MHUH, Khiyam U, Malik J. Altitude-Related Venous Thrombosis With Heart Disease: An Updated Review. Curr Probl Cardiol 2024; 49:102018. [PMID: 37544620 DOI: 10.1016/j.cpcardiol.2023.102018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
Altitude-related venous thrombosis (ARVT) is a condition of growing concern among individuals engaged in high-altitude travel and activities. This updated review explores the epidemiology, pathophysiological mechanisms, clinical presentations, and management of ARVT based on a thematic analysis and synthesis of the existing literature. ARVT's multifactorial etiology involves the interplay of hypobaric hypoxia and endothelial dysfunction, creating a procoagulant state and increasing the risk of thrombosis. Common clinical manifestations include pain, swelling, and redness in the extremities, necessitating accurate and timely diagnosis, particularly in remote settings. Thromboprophylaxis during high-altitude travel and activities plays a crucial role in reducing the risk of ARVT, while anticoagulation remains the mainstay of management. Further research is needed to optimize preventive and treatment strategies, enhancing patient outcomes and safety in high-altitude environments.
Collapse
Affiliation(s)
| | - Binish Ayub Ahmad
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | | | | | | | - Umer Khiyam
- Department of Medicine, Peshawar Medical College, Peshawar, Pakistan
| | - Jahanzeb Malik
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan.
| |
Collapse
|
2
|
Deskit P, Badwal M, Wangchuk PT. High Altitude-Induced Testicular Infarct: a Rare Occupational Hazard. Indian J Surg 2022; 84:1325-1327. [PMID: 35125751 PMCID: PMC8809222 DOI: 10.1007/s12262-022-03312-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/28/2022] [Indexed: 12/27/2022] Open
Abstract
Visit to high altitude with its hypoxic hypobaric environment poses various physiological and biochemical challenges to a human body. If the body is not able to cope up to this changed environment, it leads to various maladies of high altitude like high altitude cerebral oedema, high altitude pulmonary oedema and spontaneous vascular thrombosis. There are reports of high altitude-induced deep venous thrombosis, pulmonary embolism, mesenteric ischemia etc. We report a unique case of high altitude-induced testicular infarct in a previously healthy individual after a brief stay at the high-altitude region Ladakh.
Collapse
|
3
|
Lahiri R, Chauhan U, Kumar A, Puliyath N. Undiagnosed bilateral complete cervical rib with subclavian artery aneurysm presenting as acute ischaemic limb following high-altitude expedition. BMJ Case Rep 2021; 14:14/2/e241194. [PMID: 33637509 PMCID: PMC7919562 DOI: 10.1136/bcr-2020-241194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Arterial thoracic outlet syndrome is relatively rare and often exclusively seen in the presence of bony anomalies. High-altitude (HA) travel is commonly associated with thrombosis; however, arterial thromboembolism is less frequently described. We describe a case of a young man with undiagnosed bilateral cervical rib, who went for an HA trek, subsequent to which developed acute limb ischaemia of right arm. Diagnostic workup revealed a subclavian artery aneurysm as well along with complete bony bilateral cervical ribs. Thoracic outlet syndrome should be kept as a differential diagnosis in a case of acute limb ischaemia in a healthy adult.
Collapse
Affiliation(s)
- Raja Lahiri
- CVTS, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Udit Chauhan
- Intervention Radiology, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Ajay Kumar
- Cardiac Anaesthesia, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | | |
Collapse
|
4
|
Trunk AD, Rondina MT, Kaplan DA. Venous Thromboembolism at High Altitude: Our Approach to Patients at Risk. High Alt Med Biol 2019; 20:331-336. [PMID: 31479310 DOI: 10.1089/ham.2019.0049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a prevalent disorder that confers substantial cardiovascular morbidity and, in serious cases, death. VTE has a complex and incompletely understood etiopathogenesis with genetic, acquired, and environmental risk factors. As the focus of this review, one environmental risk factor, which may interact with other risk factors such as hereditary and/or acquired thrombophilias, is travel to high altitude (HA), although current evidence is limited. As guidelines do not directly address this topic, we will discuss the epidemiology of HA-VTE, review the putative mechanisms for thrombosis at HA, and discuss our clinical approach to both risk stratification and counseling, including specific pharmacologic and nonpharmacologic recommendations for patients with elevated VTE risk before they travel to HA.
Collapse
Affiliation(s)
- Andrew D Trunk
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Matthew T Rondina
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah.,Department of Internal Medicine and GRECC, George E. Wahlen VAMC, Salt Lake City, Utah.,Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah.,Molecular Medicine Program, Eccles Institute of Human Genetics, University of Utah, Salt Lake City, Utah
| | - David A Kaplan
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
| |
Collapse
|
5
|
Abstract
Ultrasonography is a noninvasive, reliable, repeatable, and inexpensive technology that has dramatically changed the practice of medicine. The clinical use of portable ultrasound devices has grown tremendously over the last 10 years in the fields of intensive care, emergency medicine, and anesthesiology. In this review we present the various ways that handheld portable ultrasound devices can be used in austere environments. The purpose of this review is to consider the wide-ranging applications for providers going into the austere environment, which include pulmonary, ocular, vascular, and trauma evaluations, the postdisaster setting, and the role of ultrasonography in tropical diseases. This review is not meant to be a comprehensive how-to guide for each study type, but an overview of some of the more common wilderness applications. This review also focuses on the limitation of each study type. The goal is to help wilderness medicine providers feel more comfortable incorporating ultrasonography as part of their tool kit when heading into austere environments.
Collapse
Affiliation(s)
| | - N Stuart Harris
- 2 Division of Wilderness Medicine, Massachusetts General Hospital, Boston, Massachusetts.,3 Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
6
|
Shang C, Wuren T, Ga Q, Bai Z, Guo L, Eustes AS, McComas KN, Rondina MT, Ge R. The human platelet transcriptome and proteome is altered and pro-thrombotic functional responses are increased during prolonged hypoxia exposure at high altitude. Platelets 2019; 31:33-42. [PMID: 30721642 DOI: 10.1080/09537104.2019.1572876] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Exposure to hypoxia, through ascension to high altitudes (HAs), air travel, or human disease, is associated with an increased incidence of thrombosis in some settings. Mechanisms underpinning this increased thrombosis risk remain incompletely understood, and the effects of more sustained hypoxia on the human platelet molecular signature and associated functional responses have never been examined. We examined the effects of prolonged (≥2 months continuously) hypobaric hypoxia on platelets isolated from subjects residing at HA (3,700 meters) and, for comparison, matched subjects residing under normoxia conditions at sea level (50 meters). Using complementary transcriptomic, proteomic, and functional methods, we identified that the human platelet transcriptome is markedly altered under prolonged exposure to hypobaric hypoxia at HA. Among the significantly, differentially expressed genes (mRNA and protein), were those having canonical roles in platelet activation and thrombosis, including membrane glycoproteins (e.g. GP4, GP6, GP9), integrin subunits (e.g. ITGA2B), and alpha-granule chemokines (e.g. SELP, PF4V1). Platelets from subjects residing at HA were hyperactive, as demonstrated by increased engagement and adhesion to fibrinogen, fewer alpha granules by transmission electron microscopy, increased circulating PF4 and ADP, and significantly enhanced clot retraction. In conclusion, we identify that prolonged hypobaric hypoxia exposure due to HA alters the platelet transcriptome and proteome, triggering increased functional activation responses that may contribute to thrombosis. Our findings may also have relevance across a range of human diseases where chronic hypoxia, platelet activation, and thrombosis are increased.
Collapse
Affiliation(s)
- Chunxiang Shang
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China.,Oncology Department, The Fifth Hospital of Qinghai Provinces, Xining, Qinghai, China
| | - Tana Wuren
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China.,Departments of Internal Medicine and Pathology, University of Utah, Salt Lake City, UT, USA
| | - Qing Ga
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China
| | - Zhenzhong Bai
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China
| | - Li Guo
- The University of Utah Molecular Medicine Program, University of Utah, Salt Lake City, UT, USA
| | - Alicia S Eustes
- Departments of Internal Medicine and Pathology, University of Utah, Salt Lake City, UT, USA.,The University of Utah Molecular Medicine Program, University of Utah, Salt Lake City, UT, USA
| | - Kyra N McComas
- Departments of Internal Medicine and Pathology, University of Utah, Salt Lake City, UT, USA
| | - Matthew T Rondina
- Departments of Internal Medicine and Pathology, University of Utah, Salt Lake City, UT, USA.,The University of Utah Molecular Medicine Program, University of Utah, Salt Lake City, UT, USA.,Hematological Department, George E. Wahlen VAMC GRECC, Salt Lake City, UT, USA
| | - Rili Ge
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China
| |
Collapse
|
7
|
Rehan S, Pynn HJ, Williams I, Morris DS. Pulmonary embolism, frostbite and high-altitude retinopathy - a combination of life- and sight-threatening vascular complications at high altitude. Scott Med J 2018; 64:30-34. [PMID: 30354967 DOI: 10.1177/0036933018807343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The effects of high altitude on the human vascular system are well described. This case demonstrates an interesting combination of vascular complications at high altitude which were both life- and sight-threatening. In May 2017, during an attempt on Mount Everest, a 58-year-old man was forced to descend from 8000 m because of adverse weather. He suffered significant frostbite of his right hand, later requiring termination of the distal phalanx of one of the affected digits. He also experienced increasing breathlessness and went on to develop pleuritic chest pain. A CT pulmonary angiogram performed upon return to sea level revealed multiple small sub-segmental pulmonary emboli. He was anticoagulated for three months and made a full recovery. The patient also reported visual loss in the left eye and on ophthalmic examination was found to have multiple retinal haemorrhages including a left macular haemorrhage, consistent with high altitude retinopathy. The retinal haemorrhages settled with conservative management. The vascular complications suffered by this patient demonstrate the potentially fatal changes that can occur at altitude. They also serve to act as a reminder for physicians, even at sea level of the potential complications in patients returning from high altitude.
Collapse
Affiliation(s)
- Shahzaib Rehan
- 1 FY2 Doctor, Cardiff Eye Unit, University Hospital of Wales, UK
| | - Harvey J Pynn
- 2 Consultant, Emergency Medicine Department, University Hospitals, Bristol NHS Foundation Trust, Bristol Royal Infirmary, UK
| | - Ian Williams
- 3 Consultant Vascular Surgeon, Vascular Department, University Hospital of Wales, UK
| | - Daniel S Morris
- 4 Consultant Eye Surgeon, Cardiff Eye Unit, University Hospital of Wales, UK
| |
Collapse
|
8
|
Rocke AS, Paterson GG, Barber MT, Jackson AIR, Main SE, Stannett C, Schnopp MF, MacInnis M, Baillie JK, Horn EH, Moores C, Harrison P, Nimmo AF, Thompson AAR. Thromboelastometry and Platelet Function during Acclimatization to High Altitude. Thromb Haemost 2018; 118:63-71. [PMID: 29304526 PMCID: PMC6260116 DOI: 10.1160/th17-02-0138] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Interaction between hypoxia and coagulation is important given the increased risk of thrombotic diseases in chronically hypoxic patients who reside at sea level and in residents at high altitude. Hypoxia alters the proteome of platelets favouring a prothrombotic phenotype, but studies of activation and consumption of specific coagulation factors in hypoxic humans have yielded conflicting results. We tested blood from 63 healthy lowland volunteers acclimatizing to high altitude (5,200 m) using thromboelastometry and assays of platelet function to examine the effects of hypoxia on haemostasis. Using data from two separate cohorts of patients following identical ascent profiles, we detected a significant delay in clot formation, but increased clot strength by day 7 at 5,200 m. The latter finding may be accounted for by the significant rise in platelet count and fibrinogen concentration that occurred during acclimatization. Platelet function assays revealed evidence of platelet hyper-reactivity, with shortened PFA-100 closure times and increased platelet aggregation in response to adenosine diphosphate. Post-expedition results were consistent with the normalization of coagulation following descent to sea level. These robust findings indicate that hypoxia increases platelet reactivity and, with the exception of the paradoxical delay in thromboelastometry clotting time, suggest a prothrombotic phenotype at altitude. Further work to elucidate the mechanism of platelet activation in hypoxia will be important and could impact upon the management of patients with acute or chronic hypoxic respiratory diseases who are at risk of thrombotic events.
Collapse
Affiliation(s)
- Alistair S Rocke
- Apex (Altitude Physiology Expeditions), Edinburgh, United Kingdom
| | - Gordon G Paterson
- Apex (Altitude Physiology Expeditions), Edinburgh, United Kingdom.,Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Matthew T Barber
- Apex (Altitude Physiology Expeditions), Edinburgh, United Kingdom
| | - Alexander I R Jackson
- Apex (Altitude Physiology Expeditions), Edinburgh, United Kingdom.,Clinical and Experimental Sciences Academic Unit, University of Southampton, Southampton, United Kingdom
| | - Shona E Main
- Apex (Altitude Physiology Expeditions), Edinburgh, United Kingdom
| | - Calum Stannett
- Apex (Altitude Physiology Expeditions), Edinburgh, United Kingdom
| | - Martin F Schnopp
- Apex (Altitude Physiology Expeditions), Edinburgh, United Kingdom
| | | | - J Kenneth Baillie
- Apex (Altitude Physiology Expeditions), Edinburgh, United Kingdom.,Division of Genetics and Genomics, The Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Elizabeth H Horn
- Department of Clinical Haematology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Carl Moores
- Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - Paul Harrison
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Alastair F Nimmo
- Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - A A Roger Thompson
- Apex (Altitude Physiology Expeditions), Edinburgh, United Kingdom.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
9
|
Malani S, Chadha D, Banerji A. Biventricular thrombosis in a structurally normal heart at high altitude. BMJ Case Rep 2014; 2014:bcr-2014-204520. [PMID: 24879736 DOI: 10.1136/bcr-2014-204520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a rare case of biventricular thrombus in a young patient with a structurally normal heart at high altitude, complicated with pulmonary embolism. Detailed evaluation revealed him to have protein S deficiency. Altered environmental conditions at high altitude associated with protein S deficiency resulted in thrombus formation at an unusual location; the same is discussed in this case report.
Collapse
Affiliation(s)
- Susheel Malani
- Department of Cardiology, MH (CTC), Pune, Maharashtra, India
| | - Davinder Chadha
- Department of Cardiology, MH (CTC), Pune, Maharashtra, India
| | - Anup Banerji
- Department of Cardiology, Command Hospital, Udhampur, Jammu and Kashmir, India
| |
Collapse
|
10
|
Howden R, Kleeberger SR. Genetic and Environmental Influences on Gas Exchange. Compr Physiol 2012; 2:2595-614. [DOI: 10.1002/cphy.c110060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
11
|
Evans CS, Harris NS. Ultrasound and Ski Resort Clinics: Mapping Out the Potential Benefits. Wilderness Environ Med 2012; 23:239-47. [PMID: 22704080 DOI: 10.1016/j.wem.2012.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Revised: 03/21/2012] [Accepted: 03/22/2012] [Indexed: 01/10/2023]
|
12
|
Zafren K, Feldman J, Becker RJ, Williams SR, Weiss EA, Deloughery T. D-dimer is not elevated in asymptomatic high altitude climbers after descent to 5340 m: the Mount Everest Deep Venous Thrombosis Study (Ev-DVT). High Alt Med Biol 2012; 12:223-7. [PMID: 21962065 DOI: 10.1089/ham.2010.1101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We performed this study to determine the prevalence of elevated D-dimer, a marker for deep venous thrombosis (DVT), in asymptomatic high altitude climbers. On-site personnel enrolled a convenience sample of climbers at Mt. Everest Base Camp (Nepal), elevation 5340 m (17,500 ft), during a single spring climbing season. Subjects were enrolled after descent to base camp from higher elevation. The subjects completed a questionnaire to evaluate their risk factors for DVT. We then performed a D-dimer test in asymptomatic individuals. If the D-dimer test was negative, DVT was considered ruled out. Ultrasound was available to perform lower-extremity compression ultrasounds to evaluate for DVT in case the D-dimer was positive. We enrolled 76 high altitude climbers. None had a positive D-dimer test. The absence of positive D-dimer tests suggests a low prevalence of DVT in asymptomatic high altitude climbers.
Collapse
Affiliation(s)
- Ken Zafren
- Division of Emergency Medicine, Stanford University Medical Center, Stanford, California, USA.
| | | | | | | | | | | |
Collapse
|
13
|
Vearrier D, Greenberg MI. Occupational health of miners at altitude: adverse health effects, toxic exposures, pre-placement screening, acclimatization, and worker surveillance. Clin Toxicol (Phila) 2011; 49:629-40. [PMID: 21861588 DOI: 10.3109/15563650.2011.607169] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Mining operations conducted at high altitudes provide health challenges for workers as well as for medical personnel. OBJECTIVE To review the literature regarding adverse health effects and toxic exposures that may be associated with mining operations conducted at altitude and to discuss pre-placement screening, acclimatization issues, and on-site surveillance strategies. METHODS We used the Ovid ( http://ovidsp.tx.ovid.com ) search engine to conduct a MEDLINE search for "coal mining" or "mining" and "altitude sickness" or "altitude" and a second MEDLINE search for "occupational diseases" and "altitude sickness" or "altitude." The search identified 97 articles of which 76 were relevant. In addition, the references of these 76 articles were manually reviewed for relevant articles. CARDIOVASCULAR EFFECTS: High altitude is associated with increased sympathetic tone that may result in elevated blood pressure, particularly in workers with pre-existing hypertension. Workers with a history of coronary artery disease experience ischemia at lower work rates at high altitude, while those with a history of congestive heart failure have decreased exercise tolerance at high altitude as compared to healthy controls and are at higher risk of suffering an exacerbation of their heart failure. PULMONARY EFFECTS: High altitude is associated with various adverse pulmonary effects, including high-altitude pulmonary edema, pulmonary hypertension, subacute mountain sickness, and chronic mountain sickness. Mining at altitude has been reported to accelerate silicosis and other pneumoconioses. Miners with pre-existing pneumoconioses may experience an exacerbation of their condition at altitude. Persons traveling to high altitude have a higher incidence of Cheyne-Stokes respiration while sleeping than do persons native to high altitude. Obesity increases the risk of pulmonary hypertension, acute mountain sickness, and sleep-disordered breathing. NEUROLOGICAL EFFECTS: The most common adverse neurological effect of high altitude is acute mountain sickness, while the most severe adverse neurological effect is high-altitude cerebral edema. Poor sleep quality and sleep-disordered breathing may contribute to daytime sleepiness and impaired cognitive performance that could potentially result in workplace injuries, particularly in miners who are already at increased risk of suffering unintentional workplace injuries. OPHTHALMOLOGICAL EFFECTS: Adverse ophthalmological effects include increased exposure to ultraviolet light and xerophthalmia, which may be further exacerbated by occupational dust exposure. RENAL EFFECTS: High altitude is associated with a protective effect in patients with renal disease, although it is unknown how this would affect miners with a history of chronic renal disease from exposure to silica and other renal toxicants. HEMATOLOGICAL EFFECTS: Advanced age increases the risk of erythrocytosis and chronic mountain sickness in miners. Thrombotic and thromboembolic events are also more common at high altitude. MUSCULOSKELETAL EFFECTS: Miners are at increased risk for low back pain due to occupational factors, and the easy fatigue at altitude has been reported to further predispose workers to this disorder. TOXIC EXPOSURES: Diesel emissions at altitude contain more carbon monoxide due to increased incomplete combustion of fuel. In addition, a given partial pressure of carbon monoxide at altitude will result in a larger percentage of carboxyhemoglobin at altitude. Miners with a diagnosis of chronic obstructive pulmonary disease may be at higher risk for morbidity from exposure to diesel exhaust at altitude. CONCLUSIONS Both mining and work at altitude have independently been associated with a number of adverse health effects, although the combined effect of mining activities and high altitude has not been adequately studied. Careful selection of workers, appropriate acclimatization, and limited on-site surveillance can help control most health risks. Further research is necessary to more completely understand the risks of mining at altitude and delineate what characteristics of potential employees put them at risk for altitude-related morbidity or mortality.
Collapse
Affiliation(s)
- David Vearrier
- Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA 19102, USA
| | | |
Collapse
|
14
|
Krüger T, Liske B, Ziemer S, Lindemann S, Ziemer G. Thrombolysis to Treat Thrombi of the Aortic Arch. Clin Appl Thromb Hemost 2010; 17:340-5. [DOI: 10.1177/1076029610364519] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Thoracic mobile aortic mural thrombus (TAMT) of the aortic arch is a rare condition. We report 3 cases of symptomatic TAMT treated with systemic alteplase (tissue plasminogen activator [t-PA]) thrombolysis. The first patient was symptomatic with repetitive thromboembolism to the left brachial artery. She was treated with repetitive thrombolysis after surgical embolectomy of the brachial artery. The second patient was symptomatic with splenic infarction and mesenteric ischemia. She was treated with a single cycle of systemic thrombolysis followed by ileocoecal resection. The third patient presented with a TAMT obstructing the left common carotid artery, causing ischemic stroke. After systemic thrombolysis, a reduction in thrombus size was documented; however, the patient died later, of acute heart failure, during the clinical course. On follow-up 6 months after the incidences, the 2 surviving patients were in good condition and free of thromboembolic events. We show that systemic thrombolytic therapy can be performed successfully in patients with TAMT.
Collapse
Affiliation(s)
- Tobias Krüger
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital of Tübingen, Germany,
| | - Benjamin Liske
- Department of Neurology, University Hospital of Tübingen, Germany
| | - Sabine Ziemer
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital of Tübingen, Germany
| | | | - Gerhard Ziemer
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital of Tübingen, Germany
| |
Collapse
|