ATRIAL FIBRILLATION

Alaska, Denali National Park, Mount McKinley, West Buttress

Jack Ziegler (50) registered with the National Park Service as a member of a Rainier Mountaineering, Inc., guided expedition, with Greg Collins being the lead guide. The expedition flew onto the mountain via Hudson Air Service and proceeded up on a normal schedule. The expedition ultimately climbed to the 17,200-foot level, arriving there on June 29. Ziegler stated that while at 17,200 feet, he had a feeling of “unwellness.” He had experienced a bad headache but that had been relieved by Motrin. He also suffered a bout of nausea that was ameliorated by sitting up and breathing deeply. The lead guide ultimately decided to bring him down to the 14,200- foot camp for evaluation, and then planned on continuing to basecamp. While descending from 17,200 feet, Ziegler stated he felt very exhausted with a lack of energy and SOB (shortness of breath). He felt that this was not normal for him, as he usually felt much better under these conditions because of his level of physical fitness. Upon arrival at 14,200 feet, he immediately went to the Ranger medical camp.

Examination revealed a pulse of 96 with a blood pressure of 80/70 mmHg. Patient had a five-year history of atrial fibrillation, but it had been controlled with a pulmonary vein electrical isolation procedure. Patient was started on 15 LPM oxygen via non-rebreather mask and given 325mg aspirin. This relieved the chest pain, but his blood pressure was still dangerously low. The Lama helicopter was placed on standby for an emergency evacuation and a phone call was made to the patient’s cardiologist in New York. A course of medical care was agreed upon and the patient was given a 500cc fluid challenge via an IV bolus of normal saline. This had a salubrious effect, and the patient’s vital signs began to stabilize.

However, throughout the rest of the period Ziegler was being treated, his heart rate would not increase to the point necessary to maintain sufficient cardiac output. The decision was made that it would not be in the best interest of the patient if he attempted to walk to basecamp, and so would remain under the care of the NPS. Throughout the entire period Ziegler was at 14,200 feet, he was never able to maintain any physical effort in excess of five minutes. During this period of time, the weather was deteriorating and did not improve sufficiently until July 9, at which time the Lama flew to 14,200 feet and evacuated the patient to the 7,200-foot basecamp. The patient’s condition had improved enough so that farther evacuation was not required. Following a consultation with the NPS physician sponsor Dr. Jennifer Dow, Ziegler was released following another physical examination by the Park medic at the camp. He flew to Talkeetna on his own with Hudson Air Service. He then went to a cardiologist for consultation.

Analysis

Jack Ziegler did not decide to climb Denali on a whim. Not only was he a physician himself, he had also consulted with his cardiologist prior to the expedition. Atrial fibrillation had not been problematic for the last three years and stress/cardiac tests had proven negative. What occurred was simply a case of bad luck on his part, but it should be noted that this highlights the need for individuals with any sort of cardiac or medical history to be aware that the affliction may suddenly reappear. This is especially true in a harsh environment of high altitude and cold weather. This climber was lucky in that all turned out well. Others on the mountain who have suffered cardiac events have not been as fortunate. (Source: Edited from a report by John Loomis, Ranger)