topeesp.gif (5672 bytes)

[ Index ]

EXERCISE-PCVC Mailing List

Messages

Go to #: 22
Go to #: 21

#21 De:  Jorge O. Sanagua <jsanagua@satlink.com>
Enviado: Lunes, 31 de Enero de 2000 07:10 p.m.
Asunto: Aconcagua
Sponsored by: Laboratorios Bago
Apreciados amigos de Exercise,
Les envio un resumen de reportes del diario Clarin de Argentina publicados en estos ultimos dias en relacion a los accidentes y muertes en el Aconcagua. Como es un tema que esta relacionado con la Cardiologia y Medicina del Deporte, seria interesante conocer sus opiniones y experiencias que puedan enriquecer este Foro. Algunas de las preguntas que se deben hacer y responder son las siguientes: ¿Cuales son la complicaciones patologicas mas frecuente de la practica del montañismo? ¿Cuales son las complicaciones cardio-vasculares y su mecanismofisio-patologico? ¿ Podemos prevenir estas complicaciones con un examen medico previo? ¿Es frecuente que gente muy entrenada y con experiencia desarrolle una patologia de montaña ?.
Saludos cordiales
Prof. Dr. Jorge O. Sanagua
Cardiologia del Ejercicio- Sports Cardiology
Moderador exercise-pcvc
--------------------------------------------------------------------------------
CASI CIEN AVENTUREROS MUERTOS EN EL ACONCAGUA. ¿Cualquiera puede subir?
El Aconcagua (6.962 metros ) es, segun la vertiente que se elija para escalarlo, un pico de acceso relativamente sencillo o de extrema peligrosidad. Pero, ultimamente, la falta de reglas claras y controles especificos sobre aquellos que se atreven a desafiarlo ha generado caos. Y pesimas noticias. Cada año, más de 3.000 personas -no todos ellos andinistas calificados- invaden sus paredes. Algunos consiguen su objetivo:  hacer cumbre. Pero muchos otros mueren o sufren lesiones irreversibles. En esta temporada, que se inició en noviembre y concluira en marzo, las victimas fatales ya son 7. Uno de los ultimos montañistas muerto fue el japones Yshigl Tamiharu, de 32 años, quien fue encontrado sin vida el lunes en su carpa, dentro de su bolsa de dormir, tras haber sufrido un edema de pulmon mientras descansaba en el campamento basede Plaza de Mulas (4.200 metros), en la ladera noroeste. Pero el tema es aun mas complejo: una gran parte de los que intentan la ascension del Aconcagua son turistas sin conocimientos basicos de montañismo y solo cuentan con el amparo de los guias. No hay controles medicos obligatorios ni revision de equipamiento basico y tampoco se requieren los datos tecnicos ni informes de capacitacion y experiencia de los aspirantes. Sin embargo, hasta ahora nada se ha dicho sobre establecer un control medico o imponer normas minimas para achicar los margenes de peligro. La controversia gira en torno de mantener al andinismo en una orbita de completa libertad deportiva. Por ahora solo se impide el ascenso a los menores de 14 años. A juzgar por la cifra de accidentes fatales, parece poco.
RESCATAN A UN ANDINISTA ITALIANO Y A OTRO AUSTRIACO DEL ACONCAGUA
Las patrullas de socorro del Aconcagua bajaron a dos andinistas extranjeros, uno de ellos con edemas pulmonar y cerebral, y el otro con un grave congelamiento en una pierna. El caso más urgente de los ultimos dos rescates fue el del italiano Enrico Podesta, de 33 años, radicado en Genova. Lo trajeron en un helicoptero Lama de la Fuerza Aerea desde el campamento Plaza Argentina (4.300 metros) del Glaciar de los Polacos, en la ladera oriental. En la noche del jueves sintio nauseas y fatiga y no se podía tener en pie. Un medico del servicio sanitario del parque Aconcagua constato que había desarrollado edema pulmonar y lo coloco en una camara hiperbarica portatil. Esta camara se parece a una bolsa de dormir con un visor, pesa 4 kilos y es inflada con oxigeno. Con este metodo se generan condiciones de menor altura y disminuye el edema pulmonar.
UN EXPERIMENTADO ESCALADOR SALTEñO MURIO EN EL ACONCAGUA
Un experimentado andinista salteño se convirtió ayer en la septima victima fatal del Aconcagua en lo que va del año. Sufrio una descompostura mientras ascendia por la ladera noroeste o "de los refugios", y murio poco despues a raiz de un paro cardiaco. La expedicion se habia dividido en dos. Lisi estaba en el segundo contingente, mas retrasado. "En la noche del martes todos estaban bien, jugaron al truco, y al amanecer Lisi desperto con fuerte tos", dijo a Clarin una fuente cercana a la victima. Relato que tenia dificultades para respirar y que le hicieron respiracion boca a boca y le administraron medicamentos. Sus compañeros suspendieron la ascension para tratar de bajarlo desde Nido de  Condores (5.000 metros) hasta el campamento de Plaza de Mulas (4.300 metros). Escaladores pampeanos que retornaban de la cima norte dieron aviso a la patrulla de rescate y al medico establecidos en Plaza de Mulas. Se dispuso un inmediato auxilio. La patrulla de rescate comprobo a las 9.45 que Lisi habia muerto, posiblemente debido a edema pulmonar seguido de paro cardiaco UNA MEXICANA MURIO CUANDO INTENTABA ESCALAR EL ACONCAGUA Una andinista mexicana de 39 años murio a causa de un paro cardiorespiratorio, cuando intentaba hacer cumbre. La mujer integraba un contingente de seis mexicanos que, en compañia de oficiales del Ejercito Argentino, pretendian llegar a la cima del Aconcagua. En la tarde del sabado, Justina Elia Martínez Quiros sufrio una descompensacion en la base Nido de Condores, a 5.400 metros de altura. "Padecia signos de agotamiento y deshidratacion", Ella decidio abandonar a su grupo para recuperarse y fue asistida por la patrulla de rescate. El equipo de guardaparques y paramedicos, que se encontraba a pocos metros realizando tareas de prevencion, decidio bajar a la mujer en una camilla. A los 15 minutos de iniciado el descenso, la deportista sufrio un paro cardio-respiratorio que le provoco la muerte inmediata. Martinez Quiros se habia realizado un chequeo medico previo, en el campamento de Plaza de Mulas, a 4.300 metros de altura, sin presentar problemas de salud.
LOS MENORES DE 14 AñOS NO PODRAN SUBIR AL ACONCAGUA
Los menores de 14 años no podran subir al Aconcagua porque no existen estudios ni experiencia medica para tratar las patologias causadas por los ascensos a grandes alturas enos niños. Los responsables de la seguridad de la montaña mas alta de America, dictaron la resolucion despues de prohibir el ingreso de una pareja de andinistas brasileños con sus hijos de 4 y 7 años. La atraccion por la altura y la sensacion de libertad que invade a muchos andinistas, a veces no les permite medir los riesgos que este deporte supone. No es la primera vez que ocurre esto. En 1996, una andinista alemana fue  descubierta en el campamento Plaza de Mulas, a 4.300 metros de altura, con su hija de 3 años. La niña era llevada semiescondida en una mochila. Intervino la Justicia y ordeno el descenso de la pequeña. Estos intentos obligaron al Gobierno a reglamentar el ingreso de niños y adolescentes al Aconcagua. Los andinistas de entre 14 y 20 años, que aun no tienen la mayoria de edad, deberan subir con la autorizacion expresa de ambos padres.

Dear friends of Exercise: I send you a summary of reports from the "Clarin" newspaper from Argentina, published in recent days about accidents and deaths on the Aconcagua. As this is a topic that is related to Cardiology, and Sports Medicine, it would be interesting to learn your opinions and experiences that may enrich this Forum. Some of the questions that must be done and you should answer, are the following:
Which are the most frequent pathologic complications in mountain climbing? Which are the cardiovascular complications and their physiopathologic mechanism? Can we prevent this complications with a previous medical examination? Is it frequent for very trained people and with experience to develop a mountaineering pathology?
Cordially,
Prof. Dr. Jorge O. Sanagua
Cardiologia del Ejercicio- Sports Cardiology
Moderador exercise-pcvc
--------------------------------------------------------------------------------
ALMOST A HUNDRED DEAD ADVENTURERS ON THE ACONCAGUA Anyone can climb?
The Aconcagua (6,962 meters) is, according to the slope chosen to climb it, a peak relatively easy or extremely dangerous to access. But lately, the lack of clear rules and specific controls on those who dare to challenge it, has generated chaos. And very bad news. Each year more than 3,000 people -not all of them qualified climbers- invade its walls. Some achieve its goal: to reach the peak. But many others die, or suffer irreversible injuries. In this season, that began on November, and will end on March, the fatal victims are already 7. One of the last dead mountaineers was the Japanese Yshigi Tamiharu, 32 years old, who was found dead on Monday in his tent, inside his sleeping bag, afterhaving suffered a pulmonary edema while he was resting in the base camp of "Plaza de Mulas" (4,200 meters), in the northwestern slope. But the subject is even more complex: a great part of those who attempt the ascent of the Aconcagua are tourists without basic knowledge on mountain climbing, and just have the protection of the guides. There are no obligatory medical controls, or revision of basic equipment, and the technicaldata or reports about qualification and experience of the applicants are not required either. However, until now nothing has been saidabout establishing a medical control to impose minimal guidelines to narrow the margins for danger. The controversy develops around the maintenance of mountaineering in an orbit of complete sportive freedom. Currently, only those who are under 14 years old are not allowed to climb. Judging by the number of fatal accidents, it seems little.
ITALIAN AND AUSTRIAN CLIMBERS ARE RESCUED ON THE ACONCAGUA
The patrols of aid from the Aconcagua, lowered two foreign mountaineers down, one of them with pulmonary and cerebral edemas, and the other one with severe frostbite in a leg. The most urgent case of the last two rescues was the one of the Italian Enrico Podesta, 33 years old, who lives in Genoa. He was brought in a Lama helicopter of the Air Force, from the "Plaza Argentina" camp (4,300 meters) in the "Glaciar de los Polacos", in the eastern slope. On Thursday night, he felt sick and tired, and could not stand on his feet. A doctor form the sanitary service of the Aconcagua Park, verified that he had developed pulmonary edema, and placed him in a portable hyperbaric camera. This camera looks like a sleeping bag with a window, weights 4 kilos, and is inflated with oxygen. With this method, conditions of lower height are generated, and the pulmonary edema decreases.
AN EXPERIENCED CLIMBER FROM THE PROVINCE OF SALTA (ARGENTINA) DIED ON THE ACONCAGUA
Yesterday, an experienced climber from the province of Salta became the seventh fatal victime to the Aconcagua along the year. He felt sick while ascending through the northeastern slope, or the one "of the shelters", and died shortly afterwards due to heart arrest. The expedition had split in two. Lisi was in the second group, rather delayed. "On Tuesday night, everyone was all right, they played a card game, and at dawn Lisi woke up with a strong cough", said to Clarin a source close to the victim. He told that the former experienced difficulties to breath, and that he was done mouth-to-mouth resuscitation, and he was administered medication. His partners stopped the ascent to attempt to lower him down from the "Nido de Condores" (5,000 meters) until the "Plaza de Mulas" camp (4,300 meters). Climbers from La Pampa (Argentina), that returned from the northern peak, notified the rescue patrol, and the doctor established at "Plaza de Mulas". Immediate aid was organized. The rescue patrol verified at 9:45 that Lisi was dead, possibly due to pulmonary edema followed by cardiac arrest.
A MEXICAN WOMAN DIED WHEN SHE WAS TRYING TO CLIMB THE ACONCAGUA
A Mexican female climber, 39 years old, died due to a cardio-respiratory arrest when she was trying to reach the peak. The woman was part of a group of six Mexicans that, together with officials from the Argentine Army, aimed to reach the Aconcagua's peak. On Saturday afternoon, Justina Elia Martinez Quiros suffered a decompensation on the base "Nido de Condores", at 5,400 meters high. "She displayed signs of exhaustion and dehydration". She decided to give up her group to recover herself, and was aided by the rescue patrol. The forest ranger and paramedic team, that was at a few meters carrying out prevention tasks, decided to lower the woman down in a stretcher. Fifteen minutes after beginning the descent, the sportswoman suffered a cardio-respiratory arrest that caused her immediate death. Martinez Quiros had been performed a previous medical check-up, at the "Plaza de Mulas" camp, at 4,300 meters high, without presenting health problems.
UNDER-14S WILL NOT BE ALLOWED TO CLIMB THE ACONCAGUA
Under-14s will not be allowed to climb the Aconcagua because there are neither studies, nor medical experience to treat the pathologies caused by ascents to great heights in children. Those responsible for the security of the highest mountain in America, announced the resolution after forbidding entrance to a couple of Brazilian climbers with their children, 4 and 7 years old. The attraction due to its height, and the feeling of freedom that overwhelms many mountaineers, sometimes prevents them from measuring the risks that this sport implies. It is not the first time that this happens. In 1996, a German female climber, was discovered at  the "Plaza de Mulas" camp, at 4,300 meters high, with her 3-year-olddaughter. The child had been carried half-hidden in a backpack. The law intervened, and ordered the descent of the child. These attempts forced the Government to regulate the entrance of children and teens to the Aconcagua. The climbers ranging between 14 and 20 years, that are not still in the age of majority, must climb with the express authorization of both parents.

Top

#22 De:  Leonardo Roldan <lega@coopvgg.com.ar>
Enviado: Jueves 3 de Febrero de 2000 23:04
Asunto: Fibrilacion auricular paroxistica/Paroxysmal atrial fibrillation
Sponsored by: IntraMed
Estimado Dr. Jorge Sanagua,
Solicito que se distribuya en el Foro de exercise-pcvc el siguiente caso textual y sin omision de mi nombre. He recibido con agrado los mails del Congreso Virtual de Cardiologia y he podido disfrutar e interiorizarme de los diferentes temas y actualizaciones. Pero hoy le escribo por un problema personal; algo que necesita de un trato personal y espero que Ud., o algun experto integrante del Foro me pueda guiar. He tenido en noviembre pasado una Fibrilacion Auricular Paroxistica que fue exhaustivamente estudiada a raíz de un pedido mio y justificada por mi actividad de deportista de competencia. Me desempeño como enfermero en el policlinico PAMI II dela ciudad de Rosario, ademas estoy en 6to año de la carrera de medicina y juego al Rugby en el Club Atletico del Rosario, en la Union de Rugby de Buenos Aires en la primera division; tengo 27 años y los episodios me aparecieron siempre durmiendo, mi frecuencia cardiaca habitual es de 60 ppm y los estudios que me han realizado son todos normales (ecocardigrama, holter 24 hs, cateterismo del Haz de His (se disparo un aleteo auricular tipo I), Ergometria de 12 canales, Ergo-espirometria); le comento esto porque a raiz de mis actividades, los cardiologos que me atienden han llegado a la conclusion de que mi arritmia se trataria de una FA Vagal o Adrenergica y por eso se me medico con Atenolol 25 mg por dia desde hace dos dias donde estuve en Unidad Coronaria por otro episodio y a minutos de ser desfibrilado electricamente la FA cedio espontaneamente. He podido leer varios articulos que no llegan a convencerme de que estoy correctamente tratado asi que le pido que me asesore para poder consultar a un verdadero especialista de FA en deportistas jovenes ya que en cada episodio tengo la necesidad de internarme en UCO y ser desfibrilado (nunca lo han hecho porque ceden espontaneamente) agregado al hecho de que el atenolol estaria indicado en altas dosis para prevenir los ataques de FA (lo dice un articulo del congreso) y me preocuparia los efectos indeseables que podrian aparecer. He realizado en el dia de hoy una consulta con otro Medico Cardiologo especialista en arritmias, quien me diagnosticó FA paroxistica de origen vagal y me medico con 500 mg de AAS por dia (mi peso es de 105 kg) mas flecainida 100mg cada 12 horas; y, en el caso de que se volviera a repetir la arritmia se plantearia la posibilidad de una ablacion por radiofrecuencia del piso de la AI ya que en el estudio de Haz de His fue posible desencadenarme un Aleteo Auricular de Tipo I, que segun este doctor y por este dato del estudio electrofisiologico tiene posibilidades (pocas, pero las tiene) de mejorar con la ablacion por radiofrecuencia. Ademas me dijo que mi personalidad influia en este trastorno y el stress de mi trabajo tambien, sumado a que soy deportista (aumenta el vagotonismo) constituyen la triada clasica de este tipo de arritmia. Los betabloqueantes estan contraindicados si la arritmia es vagal. La solucion seria entonces mudarme a una cabaña en un lago y dedicarme a la pesca, o tomar la medicacion y seguir con mi vida. Agradezco opiniones. Desde ya muchas
Gracias.

Dear Dr. Jorge Sanagua:
I request that the following case should be distributed in the exercise-pcvc Forum, textually and without omitting my name. I have received with pleasure the mails from the First Virtual Congress of Cardiology, and I have been able to enjoy and familiarize with the different subjects and updating. But today, I am writing to you due to a personal problem; something that needs personal treatment, and I hope that you, or some expert member of the Forum will be able to guide me. I have had on last November a Paroxysmal Atrial Fibrillation, that was exhaustively studied because of my request, and justified because of my activity as a competition sportsman. I work as a nurse in the PAMI II polyclinic from the city of Rosario, besides I am in 6th year of the medicine career, and I play Rugby in the "Club Atletico del Rosario", in the Union of Rugby from Buenos Aires in first division; I am 27 years old, and the episodes always appeared while I was sleeping, my usual heart rate is 60bpm, and the studies that were carried out on me are all normal (echocardiogram, 24hs holter, His' bundle catheterization (atrial flutter type I was triggered), exercise stress testing in 12 channels, exercise stress testing and spirometer); I tell you this because due to my activities, the cardiologists that treated me concluded that my arrhythmia would be a Vagal or Adrenergic AF, and because of this I was medicated with Atenolol, 25mg per day since two days ago, when I was in the Coronary Unit due to other episode, and a few minutes before being electrically defibrillated, the AF gave in spontaneously. I read several articles that did not convince me that I am being properly treated, so I ask you to advise me to be able to consult with a true specialist in AF in young sportsmen, since in each episode I had to be admitted in ICU, to be defibrillated (they never did itbecause it gives in spontaneously), plus the fact that atenolol would be indicated in high doses to prevent AF attacks (it is mentioned in an article of the Congress) and I am worried about the unwanted effects that may appear. Today, I have carried out a consult with another Cardiologist, specialist on arrhythmias, who diagnosed paroxysmal AF of vagal origin, and medicated me with 500mg of ASA per day (I weight 105kg) plus flecainide, 100mg each 12 hours; and, if the same arrhythmia was to reappear, the possibility of a radiofrequency ablation of the lower part of the LA would be posed, since in the study of the His' bundle, it was possible to trigger an atrial flutter of type I, that according to this doctor, and due to this information from the electrophysiologic study it is possible (there is little chance, but still there is some) to be improved by the radiofrequency ablation. Besides, he told me that my personality has influence on this disorder, and the stress from my work too, plus the fact that I am a sportsman (it increases vagotonia): they make up the classic triad for this kind of arrhythmia. Beta blockers are contraindicated if the arrhythmia is vagal. The solution then, would be to move to a cottage by a lake, and devote to fishing, or take the medication and go on with my life. I thank your opinions.
Thanking you in advance. 
Leonardo Roldan

Top


© CETIFAC
Bioengineering
UNER

Update
Feb/10/2000