Key result
High-altitude exposure was not considered a major trigger for sudden cardiac death, as underlying coronary artery disease was identified in 10 of 18 cases.
Why the study?
It was uncertain whether altitude along with extreme temperatures represents an additional trigger for sudden cardiac death, despite general agreement that no direct cause-and-effect relationship exists.
Observational (n=18)
Sudden cardiac death at high altitude is primarily associated with underlying cardiovascular pathologies, such as coronary artery disease, rather than being directly triggered by altitude.
Underlying CAD drives most high-altitude SCD; case reports leave exercise-altitude interactions open.
The purpose of this retrospective study is to determine whether there is a link between high-altitude physical activity and sudden cardiac death (SCD). There is general agreement that no cause-and-effect relationship exists between altitude and SCD. However, altitude along with extreme temperatures could represent additional triggers to mortality over mountains. A series of sudden deaths occurred from 2013 to 2019 in the highest Italian region (Aosta Valley) has been revised. 18 SCDs occurred at altitudes from 1200 up to 3375 m were accounted in total. All hearts were explanted and examined according to the procedural guidelines for SCD as updated by the Association for European Cardiovascular Pathology in 2017. Most of the SCD cases were in males older than 42 years. 12 out of 18 deaths (66.67 %) occurred on the second day above 1500 m and 9 victims (50 %) died while engaged in physical exercise. Macroscopic analysis identified coronary artery disease (CAD) in 10 cases, Cardiac Hypertrophy in 4 out of 18 cases; dilated cardiomyopathy was assessed in one case, and hypertensive cardiomyopathy in one case. Microscopic analysis identified 3 Myocardial Infarction (MI) 1 arrhythmogenic cardiomyopathy of the right ventricle, 7 myocardial scleroses with coronary artery stenosis, 2 fibro-fatty infiltrations of the RV, 1 dilated cardiomyopathy and 1 Cardiac Hypertrophy. Although the small sample size, the results emphasize that altitude does not play a major role in triggering the cardiovascular events that can occur in the mountains.
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Bugelli et al. (2025) conducted an observational in Sudden cardiac death (n=18). High altitude was evaluated on Pathological cause of sudden cardiac death. High-altitude exposure was not considered a major trigger for sudden cardiac death, as underlying coronary artery disease was identified in 10 of 18 cases.
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