High-altitude pulmonary edema at a ski resort

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.

The American Journal of Cardiology, 1961

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)

Wilderness & Environmental Medicine

High altitude pulmonary edema (HAPE) is a life-threatening altitude illness that usually occurs in insufficiently acclimatized climbers in the first few days at altitudes above 2500 m. Acetazolamide is recommended for prophylaxis of acute mountain sickness, but a role for acetazolamide in the prevention of HAPE has not been established. We report a case of a trekker with previous high altitude experience who developed HAPE 8 d after arrival to altitude despite what was believed to be a conservative ascent profile.

CHEST Journal, 1979

We have demoastrated a smaD bot statistkaIIy siplftcant decrease in forced vital capacity aDd ill ........., low rates amonl 126 persons studied daily for the first three days after arrival at an altitude of 2,835 meten (9,300 ft). Nearly half of these individuals had syaptoms attrlbutable to altitude sidmess, and tIaoIewitII the _. . tIysp-A scent to altitudes over 2,413 meters (8,000 ft) produces in some individuals a variety of signs and symptoms called "altitude sickness," with the type and severity of the symptoms depending both on the rate of ascent and the altitude reached. The mildest and most common syndrome is acute mountain sickness, which is characterized by headache, nausea, and vomiting. This is usually self-limited and requires little treatment. High-altitude pulmonary edema is characterized by an accumulation of fluid and by microthrombi and hyaline membranes in the lungs.' High-altitude pumonary edema can be fatal. The third form, cerebral edema, is characterized by severe headache with a variety of neurologic signs, such as hallucinations, ataxia, and coma; this form also is occasionally fatal. Although the afHictions due to altitude have been

Annals of the American Thoracic Society, 2017

Author Contributions: S.V.C.: prepared the manuscript and performed the literature search; R.M.E.-Y.-M.: directly involved with the concerned patient care and prepared the manuscript.

Mayo Clinic Proceedings, 1998

Altitude-related illnesses are a frequent cause of morbidity and occasional mortality in travelers to high altitudes in the United States and throughout the world. The primary altitude illnesses are acute mountain sickness, high-altitude pulmonary edema, and high-altitude cerebral edema. The pathogenesis of these syndromes remains unclear despite considerable research. Altitude also has potential deleterious effects on common medical conditions including coronary artery disease, pulmonary disease, hemoglobinopathies, and pregnancy. Most of these problems A n estimated 30 million people are at risk for altituderelated illnesses in the western United States annually.' Many cases are unrecognized by the victims and by their physicians who may attribute symptoms to viral illness, "hangover," or fatigue. In addition, commercial airline travel exposes passengers to a cabin pressure equivalent of 2,500 m and allows them to travel rapidly to highaltitude destinations such as Aspen or Steamboat Springs, Colorado, where they may be exposed to even greater altitudes. Approximately 20% of tourists to Colorado ski resorts (elevation about 3,000 m) will experience acute mountain sickness (AMS)2 in comparison with 67% of climbers on Mount Rainier (elevation about 4,500 m).' Approximately 0.01 % of tourists to Colorado ski resorts will experience the serious symptoms of high-altitude pulmonary edema (HAPE) or high-altitude cerebral edema (HACE).4 In addition to AMS, HAPE, and HACE, other medical problems may occur in lowlanders who ascend to high altitudes, including peripheral edema, retinopathy, thromboembolism," disordered sleep, high-altitude bronchitis," snowblindness (ultraviolet keratitis), and exacerbation of chronic illnesses. CLINICAL FEATURES Acute Mountain Sickness AMS is the most common of the acute altitude illnesses. In most cases, the symptoms are nonspecific and include

PURPOSE/AIM The purpose of this poster is: 1. Illustrate radiographic findings of high-altitude pulmonary edema (HAPE) through the presentation of a series of cases. 2. Review physiopathological aspects of HAPE 3.Review of radiologic manisfestations os HAPE as described in scientific publications CONTENT ORGANIZATION 1. Definition of HAPE 2. Presentation of series of cases 3. Physiopathology of HAPE 4. Review of reported findings of HAPE 5. Analysis of findings of our series of cases 6. Conclusions. SUMMARY High altitude pulmonary edema is a rare entity usually encountered in high altitude sites. We present a series of 10 cases presented at our institution which lies at 2600 mt . Airspace consolidation, most frequently involving upper zones of the lungs, which resolves 48-72 hours soley with oxigen therapy are the characteristic radiographic features. There is no altitude threshold o any time limit for its occurence. Elevation of arterial capillary pressure accounts for this edema.

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

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.