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High Altitude Edema

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101. Haemodynamic studies in high altitude pulmonary oedema. (Full text)

Haemodynamic studies in high altitude pulmonary oedema. 5764965 1969 04 01 2018 11 13 0007-0769 31 1 1969 Jan British heart journal Br Heart J Haemodynamic studies in high altitude pulmonary oedema. 52-8 Roy S B SB Guleria J S JS Khanna P K PK Manchanda S C SC Pande J N JN Subba P S PS eng Journal Article England Br Heart J 0370634 0007-0769 142M471B3J Carbon Dioxide S88TT14065 Oxygen AIM IM Adult Altitude Carbon Dioxide blood Hemodynamics Humans Hypertension, Pulmonary complications Male (...) Oxygen blood Pulmonary Artery physiopathology Pulmonary Edema complications etiology physiopathology Respiration 1969 1 1 1969 1 1 0 1 1969 1 1 0 0 ppublish 5764965 PMC487443 Am Heart J. 1957 Nov;54(5):753-65 13469744 N Engl J Med. 1965 Jul 8;273:66-73 14301200 Br Heart J. 1967 May;29(3):428-31 6023736 Br Heart J. 1965 Nov;27(6):876-8 5858108 Am J Pathol. 1964 Sep;45:381-91 14212805 Circulation. 1964 Mar;29:393-408 14131411 Indian Heart J. 1966 Jul;18(3):203-6 5946426 J Clin Invest. 1937 May;16(3

1969 British Heart Journal PubMed

102. The heart at high altitude. (Full text)

The heart at high altitude. 5651242 1968 07 10 2018 11 13 0007-0769 30 3 1968 May British heart journal Br Heart J The heart at high altitude. 291-4 Jackson F F eng Journal Article England Br Heart J 0370634 0007-0769 AIM IM S Adaptation, Physiological Altitude Coronary Disease etiology Electrocardiography Heart physiology Humans Hypoxia etiology Mountaineering Pulmonary Edema etiology 68242952 1968 5 1 1968 5 1 0 1 1968 5 1 0 0 ppublish 5651242 PMC487619 Br Heart J. 1963 May;25(3):291-8

1968 British Heart Journal PubMed

103. High-altitude oedema presenting as coma. (Full text)

High-altitude oedema presenting as coma. 4723483 1973 10 11 2018 11 13 0007-1447 3 5874 1973 Aug 04 British medical journal Br Med J High-altitude oedema presenting as coma. 294-5 Radford P P eng Journal Article England Br Med J 0372673 0007-1447 AIM IM S Adult Altitude Brain Edema etiology Coma etiology Humans Hypoxia complications Male Mountaineering Pulmonary Edema etiology 73232328 1973 8 4 1973 8 4 0 1 1973 8 4 0 0 ppublish 4723483 PMC1586706 Lancet. 1965 Jan 30;1(7379):229-34 14238062

1973 British medical journal PubMed

104. Ultrastructure of high altitude pulmonary oedema (Full text)

Ultrastructure of high altitude pulmonary oedema 4787981 1974 06 14 2018 11 13 0040-6376 28 6 1973 Nov Thorax Thorax Ultrastructure of high altitude pulmonary oedema. 694-700 Heath D D Moosavi H H Smith P P eng Journal Article England Thorax 0417353 0040-6376 IM Altitude Animals Capillaries pathology Female Lung pathology Male Microscopy, Electron Pinocytosis Pulmonary Alveoli pathology Pulmonary Edema pathology Rats 1973 11 1 1973 11 1 0 1 1973 11 1 0 0 ppublish 4787981 PMC470103 Thorax. 1969

1973 Thorax PubMed

105. Effect of morphine on pulmonary blood volume in convalescents from high altitude pulmonary oedema. (Full text)

Effect of morphine on pulmonary blood volume in convalescents from high altitude pulmonary oedema. 5858108 1966 04 10 2018 11 13 0007-0769 27 6 1965 Nov British heart journal Br Heart J Effect of morphine on pulmonary blood volume in convalescents from high altitude pulmonary oedema. 876-8 Roy S B SB Singh I I Bhatia M L ML Khanna P K PK eng Case Reports Journal Article England Br Heart J 0370634 0007-0769 76I7G6D29C Morphine AIM IM Altitude Blood Volume Humans Male Morphine therapeutic use (...) Pulmonary Circulation Pulmonary Edema drug therapy 1965 11 1 1965 11 1 0 1 1965 11 1 0 0 ppublish 5858108 PMC490115 Am Heart J. 1957 Nov;54(5):753-65 13469744 Circulation. 1964 Mar;29:393-408 14131411 Lancet. 1965 Jan 30;1(7379):229-34 14238062

1965 British Heart Journal PubMed

106. Altitude-Related Disorders (Follow-up)

of these are merely an annoyance while others are life threatening. Three major syndromes, acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema (HACE), are now commonly accepted [ ] . Other related problems, such as impaired sleep and high-altitude retinal hemorrhage, often coexist with the major syndromes and deserve mention. Finally, the effects of ascent on certain special populations are briefly discussed. Related Medscape articles include and . Next: Acute (...) were promising, more recent ones do not support the use of Ginkgo biloba. In a couple of studies, Ginkgo biloba was no better than placebo in prophylaxis of AMS. [ , ] As such, the mainstay of pharmacologic treatment remains acetazolamide and dexamethasone. Portable hyperbaric bags (eg, Gamow bag) simulate descent to a lower altitude. These bags are effective for treating AMS, although they are rarely needed unless AMS is complicated with high-altitude cerebral or pulmonary edema (see High-Altitude

2014 eMedicine.com

107. Altitude-Related Disorders (Diagnosis)

of these are merely an annoyance while others are life threatening. Three major syndromes, acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema (HACE), are now commonly accepted [ ] . Other related problems, such as impaired sleep and high-altitude retinal hemorrhage, often coexist with the major syndromes and deserve mention. Finally, the effects of ascent on certain special populations are briefly discussed. Related Medscape articles include and . Next: Acute (...) were promising, more recent ones do not support the use of Ginkgo biloba. In a couple of studies, Ginkgo biloba was no better than placebo in prophylaxis of AMS. [ , ] As such, the mainstay of pharmacologic treatment remains acetazolamide and dexamethasone. Portable hyperbaric bags (eg, Gamow bag) simulate descent to a lower altitude. These bags are effective for treating AMS, although they are rarely needed unless AMS is complicated with high-altitude cerebral or pulmonary edema (see High-Altitude

2014 eMedicine.com

108. Altitude-Related Disorders (Overview)

of these are merely an annoyance while others are life threatening. Three major syndromes, acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema (HACE), are now commonly accepted [ ] . Other related problems, such as impaired sleep and high-altitude retinal hemorrhage, often coexist with the major syndromes and deserve mention. Finally, the effects of ascent on certain special populations are briefly discussed. Related Medscape articles include and . Next: Acute (...) were promising, more recent ones do not support the use of Ginkgo biloba. In a couple of studies, Ginkgo biloba was no better than placebo in prophylaxis of AMS. [ , ] As such, the mainstay of pharmacologic treatment remains acetazolamide and dexamethasone. Portable hyperbaric bags (eg, Gamow bag) simulate descent to a lower altitude. These bags are effective for treating AMS, although they are rarely needed unless AMS is complicated with high-altitude cerebral or pulmonary edema (see High-Altitude

2014 eMedicine.com

109. Altitude Illness - Pulmonary Syndromes (Overview)

> Altitude Illness - Pulmonary Syndromes Updated: Dec 11, 2017 Author: N Stuart Harris, MD, MFA, FACEP; Chief Editor: Joe Alcock, MD, MS Share Email Print Feedback Close Sections Sections Altitude Illness - Pulmonary Syndromes Overview Background Altitude illness refers to a group of syndromes that result from hypoxia. Acute mountain sickness (AMS) and are manifestations of the brain pathophysiology, while high-altitude pulmonary edema (HAPE) is that of the lung (see image shown below). Everyone (...) a leftward shift of the oxyhemoglobin dissociation curve, facilitating loading of the hemoglobin with oxygen in the pulmonary capillary. Sleep architecture is altered at high altitude, with frequent arousals and nearly universal subjective reports of disturbed sleep. [ ] This generally improves after several nights at a constant altitude, though periodic breathing (Cheyne-Stokes) is normal above 2700 m. Pathophysiology of HAPE [ , , , ] HAPE is a noncardiogenic, hydrostatic pulmonary edema, characterized

2014 eMedicine Emergency Medicine

110. Altitude Illness - Cerebral Syndromes (Overview)

> Altitude Illness - Cerebral Syndromes Updated: Feb 22, 2019 Author: N Stuart Harris, MD, MFA, FACEP; Chief Editor: Joe Alcock, MD, MS Share Email Print Feedback Close Sections Sections Altitude Illness - Cerebral Syndromes Overview Background Altitude illness refers to a group of syndromes that result from hypoxia. Acute mountain sickness (AMS) and high-altitude cerebral edema (HACE) are manifestations of the brain pathophysiology, while (HAPE) is that of the lung. Everyone traveling to altitude (...) to improve with treatment, or if HACE or HAPE are present, descend immediately. For patient education resources, see the article . Previous References Fagenholz PJ, Gutman JA, Murray AF, Noble VE, Camargo CA Jr, Harris NS. Evidence for increased intracranial pressure in high altitude pulmonary edema. High Alt Med Biol . 2007 Winter. 8(4):331-6. . MacInnis MJ, Wang P, Koehle MS, Rupert JL. The genetics of altitude tolerance: the evidence for inherited susceptibility to acute mountain sickness. J Occup

2014 eMedicine Emergency Medicine

111. Altitude Illness - Cerebral Syndromes (Follow-up)

are typically treated in 1-hour increments and then are reevaluated. See the images below. A very ataxic man with high-altitude cerebral edema (HACE) at 4250 m being assisted toward the Gamow bag. A fully inflated Gamow Bag in use. Importantly, in HACE cases, these chambers should only be used as a means of acute/temporizing care (eg, to improve a patient's ability to more safely participate in their evacuation in technical terrain). They should never be considered as a replacement for actual descent. Coca (...) , further outpatient care is not usually indicated for patients with AMS. Patients with mild HACE should have follow-up appointments in 24 hours to check for clearance of symptoms. Patients with concurrent HAPE should be immediately reported to the . Previous References Fagenholz PJ, Gutman JA, Murray AF, Noble VE, Camargo CA Jr, Harris NS. Evidence for increased intracranial pressure in high altitude pulmonary edema. High Alt Med Biol . 2007 Winter. 8(4):331-6. . MacInnis MJ, Wang P, Koehle MS, Rupert

2014 eMedicine Emergency Medicine

112. Altitude Illness - Pulmonary Syndromes (Follow-up)

phosphodiesterase-5 inhibitors (eg, sildenafil, tadalafil) have been found effective for prophylaxis of HAPE, [ , , , ] but they have not yet been studied for treatment. Previous Next: Long-Term Monitoring Outpatient treatment of mild HAPE after descent consists of bedrest. Follow up in 24 hours to check on clearance of HAPE edema. Previous References Richalet JP, Larmignat P, Poitrine E, Letournel M, Canouï-Poitrine F. Physiological Risk Factors of Severe High Altitude Illness: A Prospective Cohort Study. Am J (...) . 123 (5):1228-1234. . Rexhaj E, Rimoldi SF, Pratali L, Brenner R, Andries D, Soria R, et al. Sleep-Disordered Breathing and Vascular Function in Patients With Chronic Mountain Sickness and Healthy High-Altitude Dwellers. Chest . 2016 Apr. 149 (4):991-8. . Schoene RB. Unraveling the mechanism of high altitude pulmonary edema. High Alt Med Biol . 2004 Summer. 5(2):125-35. . Swenson ER, Maggiorini M, Mongovin S, et al. Pathogenesis of high-altitude pulmonary edema: inflammation is not an etiologic

2014 eMedicine Emergency Medicine

113. Altitude Illness - Pulmonary Syndromes (Treatment)

phosphodiesterase-5 inhibitors (eg, sildenafil, tadalafil) have been found effective for prophylaxis of HAPE, [ , , , ] but they have not yet been studied for treatment. Previous Next: Long-Term Monitoring Outpatient treatment of mild HAPE after descent consists of bedrest. Follow up in 24 hours to check on clearance of HAPE edema. Previous References Richalet JP, Larmignat P, Poitrine E, Letournel M, Canouï-Poitrine F. Physiological Risk Factors of Severe High Altitude Illness: A Prospective Cohort Study. Am J (...) . 123 (5):1228-1234. . Rexhaj E, Rimoldi SF, Pratali L, Brenner R, Andries D, Soria R, et al. Sleep-Disordered Breathing and Vascular Function in Patients With Chronic Mountain Sickness and Healthy High-Altitude Dwellers. Chest . 2016 Apr. 149 (4):991-8. . Schoene RB. Unraveling the mechanism of high altitude pulmonary edema. High Alt Med Biol . 2004 Summer. 5(2):125-35. . Swenson ER, Maggiorini M, Mongovin S, et al. Pathogenesis of high-altitude pulmonary edema: inflammation is not an etiologic

2014 eMedicine Emergency Medicine

114. Altitude Illness - Cerebral Syndromes (Treatment)

are typically treated in 1-hour increments and then are reevaluated. See the images below. A very ataxic man with high-altitude cerebral edema (HACE) at 4250 m being assisted toward the Gamow bag. A fully inflated Gamow Bag in use. Importantly, in HACE cases, these chambers should only be used as a means of acute/temporizing care (eg, to improve a patient's ability to more safely participate in their evacuation in technical terrain). They should never be considered as a replacement for actual descent. Coca (...) , further outpatient care is not usually indicated for patients with AMS. Patients with mild HACE should have follow-up appointments in 24 hours to check for clearance of symptoms. Patients with concurrent HAPE should be immediately reported to the . Previous References Fagenholz PJ, Gutman JA, Murray AF, Noble VE, Camargo CA Jr, Harris NS. Evidence for increased intracranial pressure in high altitude pulmonary edema. High Alt Med Biol . 2007 Winter. 8(4):331-6. . MacInnis MJ, Wang P, Koehle MS, Rupert

2014 eMedicine Emergency Medicine

115. Altitude Illness - Cerebral Syndromes (Diagnosis)

> Altitude Illness - Cerebral Syndromes Updated: Feb 22, 2019 Author: N Stuart Harris, MD, MFA, FACEP; Chief Editor: Joe Alcock, MD, MS Share Email Print Feedback Close Sections Sections Altitude Illness - Cerebral Syndromes Overview Background Altitude illness refers to a group of syndromes that result from hypoxia. Acute mountain sickness (AMS) and high-altitude cerebral edema (HACE) are manifestations of the brain pathophysiology, while (HAPE) is that of the lung. Everyone traveling to altitude (...) to improve with treatment, or if HACE or HAPE are present, descend immediately. For patient education resources, see the article . Previous References Fagenholz PJ, Gutman JA, Murray AF, Noble VE, Camargo CA Jr, Harris NS. Evidence for increased intracranial pressure in high altitude pulmonary edema. High Alt Med Biol . 2007 Winter. 8(4):331-6. . MacInnis MJ, Wang P, Koehle MS, Rupert JL. The genetics of altitude tolerance: the evidence for inherited susceptibility to acute mountain sickness. J Occup

2014 eMedicine Emergency Medicine

116. Altitude Illness - Pulmonary Syndromes (Diagnosis)

> Altitude Illness - Pulmonary Syndromes Updated: Dec 11, 2017 Author: N Stuart Harris, MD, MFA, FACEP; Chief Editor: Joe Alcock, MD, MS Share Email Print Feedback Close Sections Sections Altitude Illness - Pulmonary Syndromes Overview Background Altitude illness refers to a group of syndromes that result from hypoxia. Acute mountain sickness (AMS) and are manifestations of the brain pathophysiology, while high-altitude pulmonary edema (HAPE) is that of the lung (see image shown below). Everyone (...) a leftward shift of the oxyhemoglobin dissociation curve, facilitating loading of the hemoglobin with oxygen in the pulmonary capillary. Sleep architecture is altered at high altitude, with frequent arousals and nearly universal subjective reports of disturbed sleep. [ ] This generally improves after several nights at a constant altitude, though periodic breathing (Cheyne-Stokes) is normal above 2700 m. Pathophysiology of HAPE [ , , , ] HAPE is a noncardiogenic, hydrostatic pulmonary edema, characterized

2014 eMedicine Emergency Medicine

117. Altitude-Related Disorders (Treatment)

of these are merely an annoyance while others are life threatening. Three major syndromes, acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema (HACE), are now commonly accepted [ ] . Other related problems, such as impaired sleep and high-altitude retinal hemorrhage, often coexist with the major syndromes and deserve mention. Finally, the effects of ascent on certain special populations are briefly discussed. Related Medscape articles include and . Next: Acute (...) were promising, more recent ones do not support the use of Ginkgo biloba. In a couple of studies, Ginkgo biloba was no better than placebo in prophylaxis of AMS. [ , ] As such, the mainstay of pharmacologic treatment remains acetazolamide and dexamethasone. Portable hyperbaric bags (eg, Gamow bag) simulate descent to a lower altitude. These bags are effective for treating AMS, although they are rarely needed unless AMS is complicated with high-altitude cerebral or pulmonary edema (see High-Altitude

2014 eMedicine.com

118. Does Acetazolamide Prevent Altitude Sickness?

in minute ventilation. In cases of altitude related illness it is not well understood what goes wrong but, essentially, these normal adaptations are inadequate or maladaptive. The term mountain sickness includes a spectrum of illnesses, namely the following entities: acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). AMS is a clinical syndrome that occurs in someone who has ascended >2500 meters. Clinical features are the presence of a headache (...) develop from changes in altitude? The essential culprit is the fall in atmospheric pressure with an increase in altitude. While at sea level, barometric pressure (Pb) is ~760mm Hg (1atm), whereas at the summit of Mount Everest (~8800 meters high), this pressure drops to ~250mm Hg. The fraction of inspired oxygen remains constant (21% of air is made of oxygen molecules), so the net result is a decrease in the pressure of inspired oxygen. Remember that the pressure of oxygen in our alveoli is determined

2009 Clinical Correlations

119. Frequent subclinical high-altitude pulmonary edema detected by chest sonography as ultrasound lung comets in recreational climbers. (PubMed)

Frequent subclinical high-altitude pulmonary edema detected by chest sonography as ultrasound lung comets in recreational climbers. The ultrasound lung comets detected by chest sonography are a simple, noninvasive, semiquantitative sign of increased extravascular lung water. The aim of this study was to evaluate, by chest sonography, the incidence of interstitial pulmonary edema in recreational high-altitude climbers.Observational study.Eighteen healthy subjects (mean age 45 +/- 10 yrs, ten (...) males) participating in a high-altitude trek in Nepal.Chest and cardiac sonography at sea level and at different altitudes during ascent. Ultrasound lung comets were evaluated on anterior chest at 28 predefined scanning sites.At individual patient analysis, ultrasound lung comets during ascent appeared in 15 of 18 subjects (83%) at 3440 m above sea level and in 18 of 18 subjects (100%) at 4790 m above sea level in the presence of normal left and right ventricular function and pulmonary artery

2010 Critical Care Medicine

120. Congestive Heart Failure and Pulmonary Edema (Follow-up)

administration of a loop diuretic (ie, furosemide, bumetanide, torsemide) is preferred initially because of potentially poor absorption of the oral form in the presence of bowel edema. In patients with hypertensive heart failure who have mild fluid retention, thiazide diuretics may be preferred because of their more persistent antihypertensive effects. [ , ] Diuretics can be given by bolus or continuous infusion and in high or low doses. In a study of patients with acute decompensated heart failure, however (...) with medications Avoidance, or rapid treatment of, precipitating factors Precipitating factors include the following: Sleep apnea Pulmonary embolism Sepsis Arrhythmia Ischemia High altitude Anemia Hypoxemia Use of an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) is beneficial if RV failure is secondary to left ventricular (LV) failure; the efficacy of these agents in isolated RV failure is not known. The same recommendation applies for use of beta-blockers. The role

2014 eMedicine Emergency Medicine

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