Adult subacute mountain sickness—a syndrome of congestive heart failure in man at very high altitude

High-altitude pulmonary hypertension: a pathophysiological entity to different diseases

“…An excessively elevated pulmonary artery pressure (PAP) has not only been reported to cause high altitude cor pulmonale within weeks, months, or years in newcomers, but also in high-altitude residents of the Andes and nonacclimatised climbers prone to high-altitude pulmonary oedema (HAPE) [9]. The results of these studies suggest that an excessive rise in PAP is a common denominator in HAPE [9], the syndrome described by SUI et al [8] in infants and by ANAND et al [7] in adults at 6,700 m and termed "subacute mountain sickness" (SMS) of the infant and the adult, respectively, and in the illness of the high-altitude residents of the Andes termed "chronic mountain sickness" (CMS) or "Monge9s disease" in its end-stage [10].…”

“…In infants, autopsy revealed massive hypertrophy and dilatation of the right ventricle, dilatation of the pulmonary trunk, extreme medial hypertrophy of the muscular pulmonary arteries and muscularisation of the pulmonary arterioles [8]. In Indian soldiers, clinical features compatible with an acute congestive right heart failure developed during weeks 3-22, on average 11 weeks after they were stationed at altitudes between 5,800-6,700 m [7]. Before trekking to their post at extreme altitude, the soldiers had acclimatised during 1 week at 3,000 m and 1-3 weeks at altitudes between 3,000-4,500 m. After airlift to low altitude, clinical examination revealed tachypnoea, tachycardia, stasis of the jugular veins, enlargement of the liver and ascites.…”

“…Effects of subacute exposure to high altitude Indirect evidence for elevated PAP has been found in infants of Han descent born at low altitude, who died after an average of 2 months of residence in Lhasa [8] and in Indian soldiers, who failed to acclimatise at the very high altitude of 5,800-6,700 m [7]. In infants, autopsy revealed massive hypertrophy and dilatation of the right ventricle, dilatation of the pulmonary trunk, extreme medial hypertrophy of the muscular pulmonary arteries and muscularisation of the pulmonary arterioles [8].…”

“…Excessive hypoxic pulmonary vasoconstriction, and thus susceptibility to develop a right heart failure within weeks at high altitude, was first described in Colorado cattle [6]. Indian soldiers stationed at an altitude between 5,800-6,700 m [7] and Han infants in Lhasa [8] develop severe congestive right heart failure within weeks or months after arrival at high altitude. An excessively elevated pulmonary artery pressure (PAP) has not only been reported to cause high altitude cor pulmonale within weeks, months, or years in newcomers, but also in high-altitude residents of the Andes and nonacclimatised climbers prone to high-altitude pulmonary oedema (HAPE) [9].…”

Medical Research at High Altitude

“…Despite the vast amount of material on HA available .in Western literature, it is worth noting that the largest series on high altitude pulmonary oe› dema (HAPO) [3,4] and acute mountain sick› ness (AMS) [5] as well as the new entity of 'adult subacute mountain sickness' (SAMS) [6) have been described from India. Other works by our medical officers and specialists include the entity of high altitude pulmonary hypertension [7,8), one of the earliest descrip› tions of high altitude cerebral oedema (HACO) [9), and the detection of chronic mountain sickness [10].…”