High altitude pulmonary edema

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High altitude pulmonary edema (HAPE) is a life-threatening form of non-cardiogenic pulmonary edema that occurs in otherwise healthy mountaineers at altitudes above 2,500 meters (8,202 ft). Some cases have however been reported also at lower altitudes (between 1500 and 2500 m in highly vulnerable subjects), although what makes some people susceptible to HAPE is not currently known. HAPE remains the major cause of death related to high altitude exposure with a high mortality in absence of emergency treatment.

Etiology

The initial insult that causes HAPE is a shortage of oxygen which is caused by the lower air pressure at high altitudes.^[1] The mechanisms by which this shortage of oxygen causes HAPE are poorly understood, but two processes are believed to be important:

1. Increased pulmonary arterial and capillary pressures (pulmonary hypertension) secondary to hypoxic pulmonary vasoconstriction.^[2]
2. An idiopathic non-inflammatory increase in the permeability of the vascular endothelium.^[3]

Although higher pulmonary arterial pressures are associated with the development of HAPE, the presence of pulmonary hypertension may not in itself be sufficient to explain the development of edema: severe pulmonary hypertension can exist in the absence of clinical HAPE in subjects at high altitude.^[4]

Incidence

The incidence of clinical HAPE in unacclimatized travelers exposed to high altitude (~ 4,000 m) appears to be less than 1%. In over 30 years of research experience, the U.S. Army Pike's Peak Research Laboratory, utilizing about 300 sea-level resident volunteers (and more than 100 staff members) rapidly and directly exposed to high altitude, only 3 were evacuated with suspected HAPE.

Predisposing factors

Individual susceptibility to HAPE is difficult to predict. The most reliable risk factor is previous susceptibility to HAPE, and there is likely to be a genetic basis to this condition, perhaps involving the gene for angiotensin converting enzyme (ACE).

Research

In order to help understand the factors that make some individuals susceptible to HAPE, the International HAPE Database was set up in 2004.^[5] Individuals who have previously suffered from HAPE can register with this confidential database in order to help researchers study the condition.

Footnotes

1. ↑ Kenneth Baillie and Alistair Simpson. Barometric pressure calculator. Apex (Altitude Physiology EXpeditions). Retrieved on 2006-08-10. - Online altitude calculator
2. ↑ Bärtsch P, Maggiorini M, Ritter M, Noti C, Vock P, Oelz O (Oct 31 1991). "Prevention of high-altitude pulmonary edema by nifedipine.". N Engl J Med 325 (18): 1284-9. PMID 1922223.
3. ↑ Swenson E, Maggiorini M, Mongovin S, Gibbs J, Greve I, Mairbäurl H, Bärtsch P (2002). "Pathogenesis of high-altitude pulmonary edema: inflammation is not an etiologic factor.". JAMA 287 (17): 2228-35. PMID 11980523.
4. ↑ Maggiorini M, Mélot C, Pierre S, Pfeiffer F, Greve I, Sartori C, Lepori M, Hauser M, Scherrer U, Naeije R (2001). "High-altitude pulmonary edema is initially caused by an increase in capillary pressure.". Circulation 103 (16): 2078-83. PMID 11319198.
5. ↑ International HAPE database. Apex (Altitude Physiology EXpeditions). Retrieved on 2006-08-10.

External links

• Altitude sickness and high altitude acclimatisation

See also

• Acetazolamide, a drug which speeds up acclimatization to high altitudes.
• Pulmonary Edema
• Altitude sickness
• International HAPE database
• High altitude cerebral edema
• HAFE

v • d • e WikiDoc Research Resources for High altitude pulmonary edema
Articles on High altitude pulmonary edema	Most recent articles on High altitude pulmonary edema • Most cited articles on High altitude pulmonary edema • Review articles on High altitude pulmonary edema • Articles on High altitude pulmonary edema in N Eng J Med, Lancet, BMJ
Media (Slides, Video, Images, MP3) on High altitude pulmonary edema	Powerpoint slides on High altitude pulmonary edema • Images of High altitude pulmonary edema • Photos of High altitude pulmonary edema • Podcasts & MP3s on High altitude pulmonary edema • Videos on High altitude pulmonary edema
Evidence Based Medicine Regarding High altitude pulmonary edema	Cochrane Collaboration on High altitude pulmonary edema • Bandolier on High altitude pulmonary edema • TRIP on High altitude pulmonary edema
Cost Effectiveness of High altitude pulmonary edema	Cost Effectiveness of High altitude pulmonary edema
Clinical Trials Involving High altitude pulmonary edema	Ongoing Trials on High altitude pulmonary edema at Clinical Trials.gov • Trial results on High altitude pulmonary edema • Clinical Trials on High altitude pulmonary edema at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding High altitude pulmonary edema	US National Guidelines Clearinghouse on High altitude pulmonary edema • NICE Guidance on High altitude pulmonary edema • NHS PRODIGY Guidance • FDA on High altitude pulmonary edema • CDC on High altitude pulmonary edema
Textbook Information on High altitude pulmonary edema	Books and Textbook Information on High altitude pulmonary edema
Pharmacology Resources on High altitude pulmonary edema	Dosing of High altitude pulmonary edema • Drug interactions with High altitude pulmonary edema • Side effects of High altitude pulmonary edema • Allergic reactions to High altitude pulmonary edema • Overdose information on High altitude pulmonary edema • Carcinogenicity information on High altitude pulmonary edema • High altitude pulmonary edema in pregnancy • Pharmacokinetics of High altitude pulmonary edema •
Genetics, Pharmacogenomics, and Proteinomics of High altitude pulmonary edema	Genetics of High altitude pulmonary edema • Pharmacogenomics of High altitude pulmonary edema • Proteomics of High altitude pulmonary edema
Newstories on High altitude pulmonary edema	High altitude pulmonary edema in the news • Be alerted to news on High altitude pulmonary edema • News trends on High altitude pulmonary edema
Commentary on High altitude pulmonary edema	Blogs on High altitude pulmonary edema
Patient Resources on High altitude pulmonary edema	Patient resources on High altitude pulmonary edema • Discussion groups on High altitude pulmonary edema • Patient Handouts on High altitude pulmonary edema • Directions to Hospitals Treating High altitude pulmonary edema • Risk calculators and risk factors for High altitude pulmonary edema
Healthcare Provider Resources on High altitude pulmonary edema	Symptoms of High altitude pulmonary edema • Causes & Risk Factors for High altitude pulmonary edema • Diagnostic studies for High altitude pulmonary edema • Treatment of High altitude pulmonary edema
Continuing Medical Education (CME) Programs on High altitude pulmonary edema	CME Programs on High altitude pulmonary edema
International Resources on High altitude pulmonary edema	High altitude pulmonary edema en Espanol • High altitude pulmonary edema en Francais
Business Resources on High altitude pulmonary edema	High altitude pulmonary edema in the Marketplace • Patents on High altitude pulmonary edema
Informatics Resources on High altitude pulmonary edema	List of terms related to High altitude pulmonary edema

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