Delayed-Onset High Altitude Pulmonary Edema: A Case Report (original) (raw)
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Prevention and Treatment of High-Altitude Pulmonary Edema
Progress in Cardiovascular Diseases, 2010
We distinguish two forms of high altitude illness, a cerebral form called acute mountain sickness and a pulmonary form called high-altitude pulmonary edema (HAPE). Individual susceptibility is the most important determinant for the occurrence of HAPE. The hallmark of HAPE is an excessively elevated pulmonary artery pressure (mean pressure 36-51 mm Hg), caused by an inhomogeneous hypoxic pulmonary vasoconstriction which leads to an elevated pulmonary capillary pressure and protein content as well as red blood cell-rich edema fluid. Furthermore, decreased fluid clearance from the alveoli may contribute to this noncardiogenic pulmonary edema. Immediate descent or supplemental oxygen and nifedipine or sildenafil are recommended until descent is possible. Susceptible individuals can prevent HAPE by slow ascent, average gain of altitude not exceeding 300 m/d above an altitude of 2500 m. If progressive high altitude acclimatization would not be possible, prophylaxis with nifedipine or tadalafil for long sojourns at high altitude or dexamethasone for a short stay of less then 5 days should be recommended. (Prog Cardiovasc Dis 2010;52:500-506)
Indian Journal of Respiratory Care
There is an increase in the number of people traveling to high altitudes (HAs) either for work or pleasure. The rewards of such travel are generally in the form of risk of developing acute altitude illnesses or worsening of underlying medical problems. The purpose of physiology in medicine is to provide scientific information that can be used as a basis for counseling patients for these purposes. It has been seen that the symptoms of HA pulmonary edema (HAPE) ordinarily happen a few days after landing in height, and it involves dyspnea with exertion, advancing to dyspnea at rest, a dry cough, weakness, and poor exercise tolerance. [1] If the disease worsens without treatment, severe dyspnea and frank pulmonary edema are obvious, with coma and death following. Early clinical signs of the condition include tachycardia and tachypnea, mild pyrexia, basal crepitations, and dependent edema. In addition, patients generally have decreased oxygen saturation than unaffected people, but the degree of desaturation by itself has not been taken as the reliable sign of HAPE. [2] HAPE rarely occurs below 2500 m. Generally, residents of low altitudes are susceptible to HAPE if acutely exposed to HA. Some suffer
High altitude pulmonary edema in an experienced mountaineer. possible genetic predisposition
The western journal of emergency medicine, 2014
High altitude pulmonary edema (HAPE) is a form of high altitude illness characterized by cough, dyspnea upon exertion progressing to dyspnea at rest and eventual death, seen in patients who ascend over 2,500 meters, particularly if that ascent is rapid. This case describes a patient with no prior history of HAPE and extensive experience hiking above 2,500 meters who developed progressive dyspnea and cough while ascending to 3,200 meters. His risk factors included rapid ascent, high altitude, male sex, and a possible genetic predisposition for HAPE.
High Altitude Pulmonary Edema: An Update on Omics Data
High altitude pulmonary edema (HAPE) is a serious pathological condition associated with rapid ascent to high altitude occurring in non-acclimatized but otherwise healthy individuals. Decades of scientific studies on HAPE have unraveled the disease pathology, diagnosis and therapeutic interventions yet, the etiology is still unknown. A vast scientific literature is available on HAPE for a quick reference of clinicians, researchers and academicians. Perhaps, the view of mountain travelers is different and their anticipation of HAPE susceptibility comprises of personal experience. Ever-increasing number of visitors to high altitude demands the possibility of HAPE susceptibility screening, however, scientific community is yet to find a staunch solution. This review is an update of recent information on HAPE susceptibility indicators from genomics, proteomics and metabolomics as well as information pertaining to treatment/prognosis of HAPE.
High but not that High: Pulmonary Edema at Intermediate Altitude
Journal of Case Reports, 2018
Background: Pulmonary edema is a life-threatening condition which results from a persistent imbalance between the forces that drive water into the air space in the alveoli and the physiologic mechanisms that remove it. This is generally observed with rapid ascent to altitudes greater than 2500 m in absence of acclimatization in otherwise healthy individuals. Case Report: A 35 year old female tourist hailing from Hyderabad developed severe breathlessness, dizziness and chest discomfort on the second day of her trip to Shimla, Himachal Pradesh. This was associated with drop in saturation and bilateral coarse crepitations in all lung fields. She was initially managed with O 2 inhalation, bilevel positive airway pressure and furosemide. SpO 2 increased to 84% gradually. Following her chest X ray which showed bilateral lung infiltrates, she was started on morphine, furosemide, dexamethasone and referred to a tertiary care hospital in the plains. On follow up at the hospital she was told to have improved drastically in terms of saturation, hemodynamics and chest X-ray picture. Conclusion: Even though high altitude sickness manifests at altitudes higher than 2500 m, that too on rapid ascent, cases have been reported at lower heights too. And the definitive treatment is transferring the patients to lowlands.
Clinico-epidemiological profile of high altitude pulmonary edema
International Journal Of Community Medicine And Public Health
Background: With increase in the footfall to mountainous areas for occupational and recreational purposes, tackling the burden of high-altitude illnesses is a growing public health challenge. High-altitude pulmonary edema (HAPE) is a serious medical condition with peculiar epidemiological characteristics. HAPE is a significant cause of morbidity and mortality among Indian soldiers posted to high-altitude areas. Aims and objectives of the study were to study the common clinical presentation of HAPE among Indian army soldiers and to study the association between induction patterns and acclimatization status with the onset of HAPE.Methods: An observational study was undertaken to study the clinical and epidemiological characteristics of all cases of HAPE from years 2016 to 2019, among Indian army soldiers posted to high-altitude areas in Ladakh. Diagnosis was made by the Lake-Louise consensus criteria. Data was entered in Microsoft Excel and descriptive and inferential statistical tool...
m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 1 ( 2 0 1 5 ) 3 4 5 -3 5 1 a b s t r a c t Background: The criteria used for diagnosing high altitude illnesses are largely based on Western literature. This study was undertaken to define objective, simple and reliable diagnostic criteria for high altitude pulmonary edema (HAPE) in Indian soldiers at altitudes between 2700 m and 3500 m. Methods: Clinical data of 235 cases of HAPE that occurred between 2700 m and 3500 m were analysed. Receiver operator characteristic (ROC) curve analysis was used to select simple clinical parameters suitable for the diagnosis of HAPE at peripheral medical facilities. Cut-off values and their reliability for the diagnosis of HAPE were defined. Results: HAPE occurred 2.8 AE 2.2 days after arrival at altitudes between 2700 m and 3500 m.
Successful Summit of Two 8000 m Peaks After Recent High Altitude Pulmonary Edema
Wilderness & Environmental Medicine, 2019
There is little information in the literature on the safety of reascent to high altitude shortly after resolution of severe acute altitude illness, including high altitude pulmonary or cerebral edema. We present a case of a 52-y-old male climber who was diagnosed with high altitude pulmonary edema during the 2018 Everest spring climbing season, descended to low altitude for 9 d, received treatment, and returned to continue climbing with a very rapid ascent rate. Despite a very recent history of high altitude pulmonary edema and not using pharmacologic prophylaxis over a very rapid reascent profile, the climber successfully summited Mt. Everest (8848 m) and Lhotse (8516 m) without any problems.
Reviews on Environmental Health
Traveling to high altitudes for entertainment or work is sometimes associated with acute high altitude pathologies. In the past, scientific literature from the lowlander point of view was primarily based on mountain climbing. Sea level scientists developed all guidelines, but they need modifications for medical care in high altitude cities. Acute Mountain Sickness, High Altitude Pulmonary Edema, and High Altitude Cerebral Edema are medical conditions that some travelers can face. We present how to diagnose and treat acute high altitude pathologies, based on 51 years of high altitude physiology research and medical practice in hypobaric hypoxic diseases in La Paz, Bolivia (3,600 m; 11,811 ft), at the High Altitude Pulmonary and Pathology Institute (HAPPI – IPPA). These can occasionally present after flights to high altitude cities, both in lowlanders or high-altitude residents during re-entry. Acute high altitude ascent diseases can be adequately diagnosed and treated in high altitud...