Going Up to Naran and Babusar With a Heart Condition
Altitude and cold both make the heart work harder. Who can travel up the Kaghan valley safely, who should not, and what to carry if you go.
Last reviewed: by Dr. Muhammad Ali Khan, FCPS Cardiology
Key takeaways
- Thin air and cold both make the heart work harder. Together, on a mountain road, they are the reason a chest pain that never troubled you in Abbottabad can appear at Babusar Top.
- Most people with stable, well-controlled heart disease can visit the Kaghan valley. The ones who should not are those who are unstable now: recent heart attack or stent, angina that is changing, breathlessness that has worsened, or a rhythm problem not yet under control.
- The real danger up there is not the altitude itself. It is that the nearest hospital able to treat a heart attack is hours back down the valley.
- Gain height slowly, keep drinking water, keep warm, and carry your medicines in the car with you rather than in a bag in the boot.
- If chest pain starts and does not settle with rest and your GTN spray, turn around and descend. Call 1122 once you have signal, and head for DHQ Hospital Abbottabad Emergency.
Every summer, families from Abbottabad and Mansehra drive up the Kaghan valley, and every summer some of them have a bad time at altitude for reasons nobody warned them about. Thin air and cold air both make the heart work harder. On a mountain road they arrive together, and a chest pain that has never bothered you at home can turn up at Babusar Top.
Most people with stable heart disease can make the trip. This is about doing it deliberately rather than finding out on the way.
Why does height affect the heart at all?
There is less oxygen in each breath as you climb, and your body compensates in ways that all land on the heart.
The heart rate goes up. Blood pressure goes up. The blood itself thickens slightly over a few days at altitude. For a healthy heart, none of that matters. For a heart supplied by arteries that are already narrowed, it means the muscle is being asked for more work at exactly the moment its supply line is least able to deliver.
Naran sits at roughly 2,400 metres. Shogran is similar. Babusar Pass is above 4,000 metres, which is a different proposition altogether, and people underestimate it because you can drive there. Walking to that height over days gives the body time to adapt. Driving to it in an afternoon does not.
The cold is doing at least as much
This is the part that gets missed, because everyone focuses on the altitude.
Cold air narrows blood vessels, drives blood pressure up, and provokes angina in people who get it. That is the same mechanism that makes January mornings hard for heart patients in Abbottabad. Up the valley, it applies in July as well, particularly at dawn and after sunset, which is when convoys tend to set out for the pass.
Cold and altitude together are worse than either separately. Add a long drive, a heavy meal at a roadside hotel and not enough water, and you have assembled most of the conditions that provoke a cardiac event.
Who should not go
Not many people, but the list matters.
Do not travel to altitude while any of these are true:
- A heart attack or stent within the last several weeks. See what life is like after a stent for why the early period is the risky one.
- Angina that has changed recently: coming on more easily, lasting longer, or appearing at rest.
- Heart failure that is not stable, especially with worsening breathlessness or new ankle swelling.
- A rhythm problem that is not yet controlled, or a new irregular pulse you have not had checked.
- Severe valve disease, particularly if you get breathless or dizzy on moderate effort.
- Blood pressure that is not under control at sea level, because it will not improve at 4,000 metres.
If you are in any of those groups, the valley will still be there next year. Dr. Muhammad Ali Khan, Consultant Cardiologist in Abbottabad, can review whether travel is reasonable at an appointment before you commit to a booking, and that conversation is a great deal cheaper than the alternative.
The thing that actually makes this dangerous
It is not the mountain. It is the distance from a hospital.
If you develop crushing chest pain in Abbottabad, DHQ Hospital Abbottabad Emergency is minutes away and it runs around the clock. If you develop the same pain above Naran, you are hours from any facility able to treat a heart attack properly, on a single road, possibly without phone signal, possibly behind a landslide or a queue of tourist traffic. Treatment for a heart attack is measured in minutes of heart muscle lost. That equation is what changes at altitude, far more than the oxygen level does.
So the planning question has two halves. Can my heart cope with the height, and what happens up there if it cannot.
Going up sensibly
| Do this | Why |
|---|---|
| Gain height over a day or two rather than in one push | Gives the body time to adjust and gives you time to notice symptoms while you can still turn back easily |
| Sleep lower than the highest point you reach | An old mountaineering rule that works just as well from a car |
| Keep drinking water | Dehydration on a long climb thickens the blood and adds strain |
| Stay warm, including in summer | Cold provokes angina independently of altitude |
| Avoid the heaviest meals and alcohol | Both add load at the worst time |
| Do not start a hard walk on arrival day | Give it until the next morning |
| Keep medicines in the car, not the boot | You cannot reach the boot in traffic on a mountain road |
Take your blood pressure medicines, statin and blood thinners exactly as normal. People sometimes skip a diuretic on a travel day to avoid stopping the car, and then arrive dehydrated and unwell. If the timing is genuinely impractical, ask your cardiologist how to handle it rather than improvising.
When to turn around
Chest pain or tightness that does not settle within a few minutes of rest, and does not settle with your GTN spray, means stop going up and start going down.
The same applies to breathlessness that is out of proportion to the effort, a racing or irregular pulse that will not settle, dizziness or fainting, or cold sweat with any of the above. Descending is itself a treatment for altitude-related trouble, and it also happens to move you towards a hospital, which is why it is the right answer even when the cause is unclear.
Call 1122 as soon as you have signal, and head for DHQ Hospital Abbottabad Emergency. Do not decide to see how it goes overnight in a hotel in Naran.
The American Heart Association and the European Society of Cardiology both address travel and exercise for people with established cardiovascular disease, and the theme in both is the same: stable and well-treated patients can do a great deal, but the assessment happens beforehand, with a doctor who knows your case.
Before you book
If you have heart disease and a trip up the valley is planned, bring it up at your next appointment rather than treating it as a separate question. It takes two minutes and changes the advice.
Appointments with Dr. Muhammad Ali Khan can be booked through the appointments page, at either Abbottabad clinic for Rs. 2,000, Monday to Saturday, or by online video consultation for Rs. 2,500. Patients travelling from Mansehra, which is the natural stop on the way up, will find the timings and route on that page.
Frequently asked questions
Can a heart patient go up to Babusar Top?
Many can, but it deserves a specific conversation rather than a general yes. Babusar Pass sits above 4,000 metres, which is high enough that the air holds meaningfully less oxygen, and your heart compensates by beating faster and working harder. Someone with stable, well-treated coronary disease often manages it without trouble. Someone with angina that has been changing recently, a stent placed in the last few weeks, or heart failure that is not fully controlled should not be finding out on the pass itself.
How soon after a stent or a heart attack is mountain travel reasonable?
Not in the early weeks, and the exact timing depends on why the stent was needed, how much heart muscle was affected and how you are doing at your follow-up. The first weeks after a stent are when the risk of it clotting is highest, and that is the worst possible period to be several hours from a hospital with a catheterisation laboratory. Ask at your review appointment before booking anything, not after.
How do I tell altitude sickness from a heart problem?
This is genuinely difficult, which is the main reason to be cautious. Altitude sickness usually brings headache, nausea, poor sleep and general tiredness that comes on some hours after arriving. Cardiac symptoms are more likely to be chest pressure, pain spreading to the jaw or left arm, cold sweat, or breathlessness out of proportion to what you are doing. The honest advice is that if you cannot tell, treat it as cardiac and go down. Descending costs you a holiday. Guessing wrong costs more.
Kya dil ke mareez ko Naran jana chahiye?
If your condition is stable and your medicines are working, usually yes. Ask your cardiologist before you book rather than after, because the answer depends on what your heart is doing this month rather than on your diagnosis in general. Go up slowly, stay warm, keep drinking water, and keep your medicines in the car with you. If chest pain starts and the GTN spray does not settle it, do not carry on upwards. Turn back and get to a hospital.
Is the cold or the altitude the bigger problem?
For most heart patients travelling in this region, the cold does more day-to-day damage. Cold air tightens blood vessels, pushes blood pressure up and provokes angina, and it does this at Naran just as it does on a January morning in Abbottabad. Altitude adds a second load on top, and the two together are worse than either alone. Early mornings and evenings at height are when both are at their strongest, which is exactly when people set off for the pass.
What should I carry in the car?
Every medicine you take, in the car with you rather than in the boot, in original strips. A written list of your medicines and doses, and your GTN spray somewhere you can reach without unpacking. Your last ECG and discharge summary, which are worth far more to a doctor who has never met you than your recollection. Water, because dehydration on a long climb thickens the blood and adds strain. Warm clothing, even in summer, because Babusar in July is not Abbottabad in July.
Book a consultation with Dr. Muhammad Ali Khan
Consultant Cardiologist (FCPS Cardiology). Two clinic locations in Abbottabad plus online video consultation across Pakistan. Clinic fee Rs. 2,000, online Rs. 2,500. By appointment only.