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The Safety of Trekking at High Altitude After Coronary Bypass Surgery-Reply

John B. West, MD, PhD, DSc
JAMA. 1988;260(15):2218-2219. doi:10.1001/jama.1988.03410150066025.
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In Reply.—  Dr Hultgren raises some interesting points. However, I stand by our original contention that a patient who has had coronary bypass surgery would undergo some risk by trekking to an altitude of 5760 m (19 008 ft).There is overwhelming evidence of severe arterial hypoxemia at this great altitude irrespective of whether the trekker is well-acclimatized. For example, when a group of physiologists lived at a similar altitude of 5800 m (19 140 ft) for several months during the Himalayan Scientific and Mountaineering Expedition of 1960 to 1961, the mean arterial oxygen saturation was only 67% at rest and fell further during exercise.1 The calculated resting arterial oxygen partial pressure (PO2) was only 36 mm Hg. Such a low arterial PO2 must cause severe tissue hypoxia.Although the 51-year-old patient had a coronary artery bypass with apparently excellent results, it is unreasonable to assume that


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