Electrocardiographic findings in a group of physically active young adults who reside at 2,600 meters above the sea level: an exploratory study
DOI:
https://doi.org/10.47197/retos.v59.103145Keywords:
Electrocardiogram, high altitude, physical activity, exerciseAbstract
Purpose: The physiological adaptations to regular physical activity and hypobaric hypoxia associated with high-altitude residence are related to a series of cardiovascular adaptations that can generate electrocardiographic modifications. This study aimed to describe the principal findings and determine the mean values of the electrocardiographic parameters in a group of physically active young adults who reside at a high altitude. Methods: 49 young, physically active subjects (11 women) in a Sports Sciences program participated in the study. Each participant was subjected to a medical interview, a physical examination, and a resting electrocardiogram. Two physicians analyzed the electrocardiogram, searching for criteria of anatomical or physiological abnormalities; a descriptive analysis of the duration of waves and intervals and the amplitude of the T and P waves was also carried out. Results: The mean values of the electrocardiographic parameters were between the expected values. The principal findings involve sinus bradycardia and changes associated with the right side of the heart: incomplete right bundle branch block, right QRS axis deviation, and right ventricular hypertrophy. Conclusions: The findings of this study are related to other studies that describe changes in the right side of the heart in inhabitants of high altitude and sinus bradycardia in physically active subjects and, in some cases, in high-altitude residents. Every young dweller of the altitude who engages in physical activity should be submitted to a resting ECG, considering there is a high probability of finding asymptomatic changes in the ECG that could require further exploration.
Keywords: Electrocardiogram, high altitude, hypoxia, exercise
References
Akcay, M. (2018). The effect of moderate altitude on Tp-e interval, Tp-e/QT, QT, cQT and P-wave dispersion. Jour-nal of Electrocardiology, 51(6), 929–933. https://doi.org/10.1016/j.jelectrocard.2018.07.016
Aldashev, A. A., Kojonazarov, B. K., Amatov, T. A., Sooronbaev, T. M., Mirrakhimov, M. M., Morrell, N. W., Wharton, J., & Wilkins, M. R. (2005). Phosphodiesterase type 5 and high altitude pulmonary hypertension. Thorax, 60(8), 683–687. https://doi.org/10.1136/thx.2005.041954
Aryal, N., Weatherall, M., & Bhatta, Y. (2017). Electrocardiography in people living at high altitude of Nepal. Heart Asia, 9, 48–53. https://doi.org/10.1136/heartasia-2016
Bjørnstad, H., Storstein, L., Dyre Meen, H., & Hals, O. (1993). Electrocardiographic Findings According to the Level of Fitness and Sport Activity. Cardiology, 83(4), 268–279. https://doi.org/10.1159/000175980
Burtscher, M., Gatterer, H., Burtscher, J., & Mairbäurl, H. (2018). Extreme terrestrial environments: Life in thermal stress and hypoxia. A narrative review. Frontiers in Physiology, 9(MAY). https://doi.org/10.3389/fphys.2018.00572
Corrado, D., Pelliccia, A., Bjørnstad, H. H., Vanhees, L., Biffi, A., Borjesson, M., Panhuyzen-Goedkoop, N., Deligiannis, A., Solberg, E., Dugmore, D., Mellwig, K. P., Assanelli, D., Delise, P., van-Buuren, F., Anastasakis, A., Heidbuchel, H., Hoffmann, E., Fagard, R., Priori, S. G., … Thiene, G. (2005). Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common Euro-pean protocol. European Heart Journal, 26(5), 516–524. https://doi.org/10.1093/eurheartj/ehi108
Dhar, P., Sharma, V. K., Das, S. K., Barhwal, K., Hota, S. K., & Singh, S. B. (2018). Differential responses of auto-nomic function in sea level residents, acclimatized lowlanders at >3500 m and Himalayan high altitude natives at >3500 m: A cross-sectional study. Respiratory Physiology and Neurobiology, 254, 40–48. https://doi.org/10.1016/j.resp.2018.04.002
D’souza, A., Bucchi, A., Johnsen, A. B., Logantha, S. J. R. J., Monfredi, O., Yanni, J., Prehar, S., Hart, G., Cart-wright, E., Wisloff, U., Dobryznski, H., Difrancesco, D., Morris, G. M., & Boyett, M. R. (2014). Exercise training reduces resting heart rate via downregulation of the funny channel HCN4. Nature Communications, 5. https://doi.org/10.1038/ncomms4775
Goldberger, A. L., Goldberger, Z. D., & Shvilkin, A. (2018). Goldberger’s Clinical Electrocardiography A Simplified Ap-proach (Ninth Edition). Elsevier.
Guntekin, U., Gunes, Y., Tuncer, M., Gumrukcuoglu, A., & Kaya, Y. (2008). The Effect of Altitude on P-Wave and QT Duration and Dispersion. Pacing and Clinical Electrophysiology, 31(7), 889–892.
Halperin, B. D., Sun, S., Zhuang, J., Droma, T., & Moore, L. G. (1998). ECG Observations in Tibetan and Han Resi-dents of Lhasa. Journal of Electrocardiology, 31(3), 237–243.
Horii, M., Takasaki, I., Ohtsuka, K., Tsukiyama, H., Takahashi, A., Hatori, Y., & Hakuta., T. (1987). Changes of heart rate and QT interval at high altitude in alpinists: Analysis by holter ambulatory electrocardiogram. Clinical Cardiolo-gy, 10(4), 238–242. https://doi.org/10.1002/clc.4960100406
Huicho, L., & Niermeyer, S. (2007). Cross-sectional study of electrocardiographic pattern in healthy children resident at high altitude. American Journal of Physical Anthropology, 133(2), 879–886. https://doi.org/10.1002/ajpa.20563
Jensen-Urstad, K., Bouvier, F., Saltin, B., & Jensen-Urstad, M. (1998). High prevalence of arrhythmias in elderly male athletes with a lifelong history of regular strenuous exercise. Heart, 79, 161–164.
Kim, J. H., Noseworthy, P. A., McCarty, D., Yared, K., Weiner, R., Wang, F., Wood, M. J., Hutter, A. M., Picard, M. H., & Baggish, A. L. (2011). Significance of electrocardiographic right bundle branch block in trained athletes. American Journal of Cardiology, 107(7), 1083–1089. https://doi.org/10.1016/j.amjcard.2010.11.037
Kligfield, P., Gettes, L. S., Bailey, J. J., Childers, R., Deal, B. J., Hancock, E. W., Van Herpen, G., Kors, J. A., Macfarlane, P., Mirvis, D. M., Pahlm, O., Rautaharju, P., & Wagner, G. S. (2007). Recommendations for the standardization and interpretation of the electrocardiogram: Part I: The electrocardiogram and its technology: A sci-entific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. In Circula-tion (Vol. 115, Issue 10, pp. 1306–1324). https://doi.org/10.1161/CIRCULATIONAHA.106.180200
Lundby, C., Calbet, J., van Hall, G., Saltin, B., & Sander, M. (2018). Sustained sympathetic activity in altitude acclima-tizing lowlanders and high-altitude natives. Scandinavian Journal of Medicine and Science in Sports, 28(3), 854–861. https://doi.org/10.1111/sms.12976
Monge C, C., & León-Velarde S, F. (2003). El Reto Fisiológico de Vivir en los Andes. In C. Monge C & F. León-Velarde S (Eds.), El Reto Fisiológico de Vivir en los Andes (Primera, p. 52). Universidad Peruana Cayetano Heredia - Fondo Editorial.
Naeije, R. (2010). Physiological adaptation of the cardiovascular system to high altitude. Progress in Cardiovascular Diseas-es, 52(6), 456–466. https://doi.org/10.1016/j.pcad.2010.03.004
Parodi, J. B., Ramchandani, R., Zhou, Z., Chango, D. X., Acunzo, R., Liblik, K., Farina, J. M., Zaidel, E. J., Ruiz-Mori, E., Carreón, J. M. A., Liprandi, A. S., & Baranchuk, A. (2023). A systematic review of electrocardiographic changes in healthy high-altitude populations. Trends in Cardiovascular Medicine, 33(5), 309–315. https://doi.org/10.1016/j.tcm.2022.01.013
Peñaloza, D., Gamboa, R., Marticorena, E., Echevarria, M., Dyer, J., & Gutierrez, E. (1961). The influence of high altitudes on the electrical activity of the heart Electrocardiographic and vectorcardiographic observations in adoles-cence and adulthood. American Heart Journal, 61, 101–115. https://doi.org/10.1016/0002-8703(61)90522
Pinillos-Patiño, Y., Rebolledo-Cobos, R., Herazo-Beltran, Y., Oviedo-Argumedo, E., Guerrero Ospino, M., Valen-cia-Fontalvo, P., & Cortés-Moreno, G. (2022). Estilo de vida en adultos jóvenes universitarios de Barranquilla, Co-lombia. Diferencias según sexo y estatus socioeconómico. Retos, 43, 979–987.
Pollard, A. M. D. (2003). The High Altitude Medicine Handbook (Third edition). Radcliffe Medical Press.
Raynaud, J., Valeix, P., Drouet, L., Escourrou, P., & Durand, J. (1981). Electrocardiographic Observations in High Altitude Residents of Nepal and Bolivia. International. Journal of Biometeorology, 25(3), 205–217. https://doi.org/10.1007/BF02184520
Rochel Vera, C., Albertus Cámara, I., & Martínez González-Moro, I. (2024). An analysis of the factors of heart rate variability affected after a hypoxia tolerance test as a function of gender. Retos, 55, 177–183.
Rotta, A. (1947). Physiologic condition of the heart in the natives of high altitudes. American Heart Journal, 33(5), 669–676. https://doi.org/10.1016/0002-8703(47)90083-5
Rotta, A., & López, A. (1959). Electrocardiographic Patterns in Man at High Altitudes. Circulation, 19(5), 719–728. https://doi.org/10.1161/01.CIR.19.5.719
Sharma, S., Drezner, J. A., Baggish, A., Papadakis, M., Wilson, M. G., Prutkin, J. M., La Gerche, A., Ackerman, M. J., Borjesson, M., Salerno, J. C., Asif, I. M., Owens, D. S., Chung, E. H., Emery, M. S., Froelicher, V. F., Heidbuchel, H., Adamuz, C., Asplund, C. A., Cohen, G., … Corrado, D. (2018). International recommendations for electrocardiographic interpretation in athletes. European Heart Journal, 39(16), 1466–1480. https://doi.org/10.1093/eurheartj/ehw631
Sharma, S., Whyte, G., Elliott, P., Padula, M., Kaushal, R., Mahon, N., & Mckenna, W. J. (1999). Electrocardio-graphic changes in 1000 highly trained junior elite athletes. British Journal of Sports Medicine, 33(5), 319–324. https://doi.org/10.1136/bjsm.33.5.319
The jamovi project. (2022). Jamovi (2.3).
West, J. B. (2012). High-altitude medicine. American Journal of Respiratory and Critical Care Medicine, 186(12), 1229–1237. https://doi.org/10.1164/rccm.201207-1323CI
Whitman, I. R., Patel, V. V., Soliman, E. Z., Bluemke, D. A., Praestgaard, A., Jain, A., Herrington, D., Lima, J. A. C., & Kawut, S. M. (2014). Validity of the surface electrocardiogram criteria for right ventricular hypertrophy: The me-sa-rv study (multi-ethnic study of atherosclerosis-right ventricle). Journal of the American College of Cardiology, 63(7), 672–681. https://doi.org/10.1016/j.jacc.2013.08.1633
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Retos
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and ensure the magazine the right to be the first publication of the work as licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of authorship of the work and the initial publication in this magazine.
- Authors can establish separate additional agreements for non-exclusive distribution of the version of the work published in the journal (eg, to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Is allowed and authors are encouraged to disseminate their work electronically (eg, in institutional repositories or on their own website) prior to and during the submission process, as it can lead to productive exchanges, as well as to a subpoena more Early and more of published work (See The Effect of Open Access) (in English).
This journal provides immediate open access to its content (BOAI, http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess) on the principle that making research freely available to the public supports a greater global exchange of knowledge. The authors may download the papers from the journal website, or will be provided with the PDF version of the article via e-mail.
