Skip to main content
Log in

Occurrence of acute myocardial infarction in winter tourists: data from a retrospective questionnaire

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Background

Every year millions of tourists spend their vacation in Tyrol, Austria during the winter season. They often perform sports at high altitudes and at low temperatures, factors that might cause acute myocardial infarction (AMI). This study aimed to evaluate the relationship of first physical activity and the onset of AMI in winter tourists.

Methods

We carried out a retrospective analysis of consecutive patients admitted to the Department of Internal Medicine III at the Medical University of Innsbruck with the diagnosis of an AMI between 2006 and 2010. We identified 172 patients as potential candidates for the questionnaire. We successfully contacted 110 patients (mean age: 60 ± 10 years). The location of visit, duration of stay, time of arrival, first sportive activity and onset of symptoms were assessed.

Results

During the first 2 days of physical activity , 56% of AMIs occurred. In tourists who suffered AMI during, or within 1 h after cessation of activity (52%), the mean time from the start of the activity to the onset of symptoms was 2.0 ± 1.7 h. 56% of patients performed less than 2.5 h of sport per week before their vacation and 70% had ≥2 cardiovascular risk factors. Although the mean planned vacation time was 8.3 ± 3.7 days, 39% of the patients suffered from AMI on the day of arrival or the day after.

Conclusion

The majority of AMIs in winter tourists happens within the first 2 days after arrival and within the first 2 days of physical activity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

AMI:

Acute myocardial infarction

CAD:

Coronary artery disease

CCS-class:

Canadian Cardiac Society-class

CK:

Creatine kinase

cTnT:

Cardiac troponin T

CVRF:

Cardiovascular risk factors

ESC:

European Society of Cardiology

LAD:

Left anterior descending

LCX:

Left circumflex artery

LVEF:

Left ventricular ejection fraction

(N)STEMI:

(Non) ST-segment elevation myocardial infarction

NYHA-class:

New York Heart Association-class

(P-)PCI:

(Primary) percutaneous coronary intervention

RCA:

Right coronary artery

SCD:

Sudden cardiac death

SD:

Standard deviation

References

  1. Amt der Tiroler Landesregierung: Statistische Handbuch Bundesland Tirol, (2009)

  2. Priori SG, Aliot E, Blomstrom-Lundqvist C, Bossaert L, Breithardt G, Brugada P et al (2001) Task force on sudden cardiac death of the European Society of Cardiology. Eur Heart J 22(16):1374–1450

    Article  PubMed  CAS  Google Scholar 

  3. Albert CM, Mittleman MA, Chae CU, Lee IM, Hennekens CH, Manson JE (2000) Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med 343(19):1355–1361

    Article  PubMed  CAS  Google Scholar 

  4. Bhaskaran K, Hajat S, Haines A, Herrett E, Wilkinson P, Smeeth L (2009) Effects of ambient temperature on the incidence of myocardial infarction. Heart 95(21):1760–1769

    Article  PubMed  CAS  Google Scholar 

  5. Buskirk ER, Kollias J, Akers RF, Prokop EK, Reategui EP (1967) Maximal performance at altitude and on return from altitude in conditioned runners. J Appl Physiol 23(2):259–266

    PubMed  CAS  Google Scholar 

  6. Klug G, Trieb T, Schocke M, Nocker M, Skalla E, Mayr A et al (2009) Quantification of regional functional improvement of infarcted myocardium after primary PTCA by contrast-enhanced magnetic resonance imaging. J Magn Reson Imaging 29(2):298–304

    Article  PubMed  Google Scholar 

  7. Nowosielski M, Schocke M, Mayr A, Pedarnig K, Klug G, Kohler A et al (2009) Comparison of wall thickening and ejection fraction by cardiovascular magnetic resonance and echocardiography in acute myocardial infarction. J Cardiovasc Magn Reson 11(1):22

    Article  PubMed  Google Scholar 

  8. Willich SN, Lewis M, Lowel H, Arntz HR, Schubert F, Schroder R (1993) Physical exertion as a trigger of acute myocardial infarction. Triggers and mechanisms of myocardial infarction study group. N Engl J Med 329(23):1684–1690

    Article  PubMed  CAS  Google Scholar 

  9. Mayr A, Mair J, Schocke M, Klug G, Pedarnig K, Haubner BJ, et al (2009) Predictive value of NT-pro BNP after acute myocardial infarction: relation with acute and chronic infarct size and myocardial function. Int J Cardiol [Epub ahead of print]

  10. Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R et al (2007) European guidelines on cardiovascular disease prevention in clinical practice: full text. Fourth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil 14(Suppl 2):S1–S113

    Article  PubMed  Google Scholar 

  11. Mittleman MA, Maclure M, Tofler GH, Sherwood JB, Goldberg RJ, Muller JE (1993) Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of myocardial infarction onset study investigators. N Engl J Med 329(23):1677–1683

    Article  PubMed  CAS  Google Scholar 

  12. Burtscher M, Faulhaber M, Kornexl E, Nachbauer W (2005) Cardiorespiratory and metabolic responses during mountain hiking and downhill skiing. Wien Med Wochenschr 155(7–8):129–135

    Article  PubMed  Google Scholar 

  13. Schmid JP, Noveanu M, Gaillet R, Hellige G, Wahl A, Saner H (2006) Safety and exercise tolerance of acute high altitude exposure (3454 m) among patients with coronary artery disease. Heart 92(7):921–925

    Article  PubMed  CAS  Google Scholar 

  14. Hutchison SJ, Litch JA (1997) Acute myocardial infarction at high altitude. JAMA 278(20):1661–1662

    Article  PubMed  CAS  Google Scholar 

  15. van ‘t Hof AW, de Vries ST, Nadal F, Niella M, Fokkert MJ, Slingerland RJ et al (2007) A case of very late stent thrombosis at high altitude. Thromb Haemost 98(6):1379–1380

    PubMed  Google Scholar 

  16. Kappert U, Wilbring M, Tugtekin SM, Alexiou K, Matschke K (2008) A fatal consequence of acute myocardial infarction in a patient with APC-resistance at high altitude. Clin Res Cardiol 97(6):407–408

    Article  PubMed  CAS  Google Scholar 

  17. Burtscher M, Faulhaber M, Flatz M, Likar R, Nachbauer W (2006) Effects of short-term acclimatization to altitude (3200 m) on aerobic and anaerobic exercise performance. Int J Sports Med 27(8):629–635

    Article  PubMed  CAS  Google Scholar 

  18. Klug G, Zwick RH, Frick M, Wolf C, Schocke MF, Conci E et al (2007) Impact of exercise capacity on myocardial high-energy phosphate metabolism. Int J Sports Med 28(8):667–672

    Article  PubMed  CAS  Google Scholar 

  19. Neill WA (1969) Effects of arterial hypoxemia and hyperoxia on oxygen availability for myocardial metabolism. Patients with and without coronary heart disease. Am J Cardiol 24(2):166–171

    Article  PubMed  CAS  Google Scholar 

  20. Cold exposure and winter mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes in warm and cold regions of Europe. The Eurowinter Group. Lancet. 1997;349(9062):1341–1346

  21. Kloner RA, Poole WK, Perritt RL (1999) When throughout the year is coronary death most likely to occur? A 12-year population-based analysis of more than 220 000 cases. Circulation 100(15):1630–1634

    PubMed  CAS  Google Scholar 

  22. Burtscher M, Pachinger O, Schocke MF, Ulmer H (2007) Risk factor profile for sudden cardiac death during mountain hiking. Int J Sports Med 28(7):621–624

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

None.

Conflicts of interest

None declared.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to B. Metzler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Klug, G., Schenk, S., Dörler, J. et al. Occurrence of acute myocardial infarction in winter tourists: data from a retrospective questionnaire. Clin Res Cardiol 100, 669–674 (2011). https://doi.org/10.1007/s00392-011-0294-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-011-0294-3

Keywords

Navigation