Current Concepts in Clinical Cardiology [antikvár]

Lessons of High-Altitude Adv. Cardiol., vol. 27, pp. 1-5 (Karger, Basel 1980) Speculations on the Pathogenesis of High-Altitude Pulmonary Edema' R. F. Grover Cardiovascular Pulmonary Research Laboratory, Division of Cardiology, Departement of Medicine, University of Colorado School of Medicine, Denver, Colo High-altitude pulmonary edema (HAPE) continues to fascinate both physicians and laymen. Here is a life-threatening ilhiess which paradoxically strikes healthy, fit, young individuals who enter mountainous areas often no higher than 9,000 ft (2,700 m). Of the hundreds of thousands of people who ascend to such altitudes, only a very few develop HAPE. With proper treatment - primarily prompt descent - complete recovery is usual, leaving no residual abnormality. Hence, it is impossible to identify the susceptible individual prior to ascent, or following recovery, except by history. No underlying cardiopulmonary or other disease is present, no unsual physiological trait has been identified, and no circumstance other than altitude exposure will precipitate this pulmonary edema. Furthermore, HAPE is apparently a uniquely human ailment, as it has never been described in any other animal species. HAPE does indeed pose an enigma. Based on numerous clinical histories, the circumstances under which HAPE develops are well recognized [4]. Usually the individual enters the mountain environment by automobile or aircraft, and within a matter of hours he is above 9,000 feet elevation. He must then remain at this or higher altitudes for at least 24 h, and usually for several days. The altitude exposure probably requires sleeping above 9,000 ft. While strenuous exercise, perhaps in the cold, e.g. cross-country skiing, are frequent associated factors, they do not appear essential to precipitate HAPE. Thus, the underlying initiating factor is fairly rapid followed by sustained exposure to an atmospheric pressure of less than 540 torr. Presumably it is not decompression per se • Supported by Program Project Grant 14985 from the National Heart, Lung, and Blood Institute, NIH.