“…With chronic hypoxemia, however, changes in the blood-oxygen dissociation curve have a profound effect, and left ventricular flow is either normal (7) or even below normal (30,31,58,62). This response may occur within 24-96 h of reaching high altitude (58) and cannot be attributed to a major increase in hematocrit. As described by Grover et al (30,31) and Moret et al (62), high altitude caused a shift to the right of the oxygen dissociation curve, despite some mild alkalosis.…”