Aortic valve stenosis and physical activity at high altitude in a female trekker: sex-specific considerations and the added value of a sports cardiology team-a case report.

Background: Recommendations for high-altitude exposure in individuals with cardiovascular disease are largely based on expert opinion. This report details sport- and sex-specific recommendations for a patient with moderate aortic valve stenosis preparing for a high-altitude trek. Case summary: A 64-year-old woman with moderate, asymptomatic aortic valve stenosis and excellent functional capacity sought sports advice before a planned trek in the Himalayas. After a multidisciplinary sports cardiology team discussion and considering limited data on sex-specific cardiovascular responses to hypoxia, the trek was deemed safe with specific precautions. The patient was advised to limit activity to moderate intensity (74% of maximal heart rate), start at low altitude, and gradually ascend, not exceeding 2500 m and to descend immediately should symptoms occur. She was also counselled on the potential influence of sex hormones on exercise tolerance at high altitude. She successfully completed the trek without incident. Follow-up after 6 months showed progression to severe aortic stenosis, for which she underwent aortic valve and root replacement. Discussion: This case demonstrates that, following comprehensive evaluation, a high-altitude trek may be feasible in selected patients with moderate aortic stenosis. It highlights the need for individualized advice, taking into account physiological responses to high-altitude exposure, and emphasizes potential sex-specific considerations, despite limited data.