Heart disease awareness in the outdoors

There is a wide range of conditions that could affect the heart, which makes heart disease the leading cause of death in the US. Heart attacks, arrhythmias, and heart failure – they could happen anytime, anywhere, and to seemingly healthy people – even hikers, bikers, backpackers, and other outdoor enthusiasts.

While the specter of heart disease shouldn’t keep you from going on that next adventure, it’s wise to get a better understanding of the risk factors, underlying science, and symptoms so you can be best prepared should something unexpected happen in the middle of a trek.

Risk factors of heart disease

The US government has run ongoing studies since 1948 investigating risk factors for heart disease in North America. They’ve found common risk factors to be:

• High cholesterol
• High blood pressure
• Diabetes
• Tobacco smoking
• Family history of heart disease

All these determinants contribute to clot formation in the bloodstream that can narrow the heart’s blood vessels. An underlying heart condition that is mild or even silent can be exacerbated by heat stress or really any physical activity that stresses the heart. If you have risk factors or concerning symptoms, it is best to discuss with your doctor before starting a new exercise or outdoor activity.

Heart attacks

About one heart attack occurs every 40 seconds in the US. It’s a sobering statistic that underscores the prevalence of heart disease and reminds us to take the risks seriously and take preventative measures when possible.

What happens during a heart attack?

Decreased blood flow to the heart from narrowed or blocked blood vessels can cause a lack of oxygen delivery to the heart muscle cells. These cells are not able to fully function which can lead to decreased blood flow to the rest of the body.

This lack of oxygenation to the different body systems can cause a range of symptoms including chest pressure, sweating, nausea, dizziness, shortness of breath, or passing out. If the heart muscle cells die it is considered a heart attack.

Pack aspirin to prevent a heart attack

Aspirin is a drug that inhibits a pathway that causes tiny cell fragments in the blood (called platelets) from sticking together. Stopping the clumping of platelets in a narrowed or blocked blood vessel in the heart by taking aspirin has been shown to reduce death and disease from heart attacks. As always, check with your doctor before starting any new medication.

looking up from below a red rock canyon, a yellow helicopter flies into view against a blue sky with some clouds

Spotting the signs of a heart attack

As an avid hiker and a physician with a specialization in wilderness medicine, I’ve seen symptoms of heart attacks in the outdoors.

Hours into a hike down the Grand Canyon’s North Rim, my friend started feeling dizzy. He was pale and clammy and did not look good. When I asked him about his medications, it turns out he had switched to naturopathic herbs for his high cholesterol a few years ago. Then he said his chest felt “tight.” I asked passing hikers and one of them happened to have aspirin in their kit. We sent word up the trail that a medical evacuation was needed, then sat down to wait in the shade for the helicopter to arrive. In this case, the aspirin held off the clotting platelets.

Not all heart problems are obvious such as the commonly known sign of crushing chest pain that radiates to the left arm. Vague symptoms such as dizziness, weakness, tightness, shortness of breath, or palpitations can all be warning signs of heart disease, but can often be overlooked during strenuous activities (like a Grand Canyon hike). 

It is best to know your individual risk factors to minimize heart problems before you head out on your outdoor trip. Knowing how to recognize an unhealthy heart can hopefully prevent a bad situation from getting worse. In the case of my friend, knowing he had high cholesterol along with his dizziness and feeling of tightness in his chest was enough for me to deduce what was happening. And we were lucky enough to come across a prepared hiker carrying aspirin.

Needless to say, aspirin should be an essential item you pack in your first aid kit, especially if you have risk factors for heart disease.

Heart palpitations

Palpitations are a sense of an excessive pounding, fast, unusually slow, or irregular heart rhythm. Palpitations can be a sensation that occurs with a normal heart beat, but if the electrical current is not being transmitted normally through the heart, this can cause an abnormal rhythm (called an arrhythmia).

Arrhythmias can occur from heart damage, abnormal electrical conduction (like atrial fibrillation known as “afib”), and can be dangerous through the interruption of normal blood flow. Exercise, caffeine, or anxiety are some causes of palpitations. Sometimes palpitations can be an indicator of an arrhythmia.

To check your heart rhythm for palpitations, feel your pulse to see if the palpitation corresponds with normal or abnormal beats. If your pulse is very fast, in some arrhythmias you can slow it down 20 – 40% of the time by forcefully exhaling against pursed lips. This method is called the “valsalva maneuver” which increases the blood pressure in your chest and briefly reduces the amount of blood flow to your heart, which in turn triggers your nervous system to slow down your fast heart rate.

Shortness of breath

Your heart and lungs work together to help you breathe by delivering oxygen to your tissues and by removing carbon dioxide. Shortness of breath is the feeling of not being able to get enough air (also known as dyspnea). When this occurs with overexertion, it may be an indicator of a heart problem. If your heart is struggling to efficiently pump blood, your lungs need to work harder to increase the oxygen delivery to your body. Shortness of breath can also be from a problem in your lungs, caused by an infection, blood clot, inflammation, or even a collapsed lung.

Beyond just the heart and lungs, other underlying issues that can cause shortness of breath are: a decreased amount of red blood cells that carry oxygen (anemia), kidney issues, or other underlying chronic conditions. Sometimes shortness of breath is from high altitude or a good workout. Chronic dyspnea should be checked with your provider.

As you can see, there are a host of reasons that could cause shortness of breath, but knowing your medical history can help your medical provider narrow down why it’s happening and help prevent further injury in the outdoors.

Heart health matters

Understanding the full landscape of heart disease, how it happens, and taking your risk factors and underlying issues into consideration can all help you better prepare for your day. Whether you’re out running errands or hiking in the Grand Canyon, having an app like GOES Health can come in handy for heart health information.