Morning Report

Nate Ostheimer, MD June 17, 2011

High Altitude Pulmonary Edema

Risk factors
Usu above 8000 feet At 14, 800 ft: 0.2-6% of population* Males Cold temperatures Pre-existing respiratory illness Vigorous exertion L>R cardiac shunts Primary Pulmonary Hypertension History of previous altitude illness
*Depends upon rate of ascent

Pathophysiology
Poor ventilatory response to hypoxia Increased sympathetic tone Exaggerated or uneven pulmonary vasoconstriction Decreased NO Increased Endothelin

Pathophysiology

Clinical
Initial
Subtle non-productive cough, mild dyspnea, decreased activity tolerance, fever. URI or bronchitis can precipitate Usually within 2-4 days of being at altitude

Later
Increased activity intolerance and dyspnea at rest Pink, frothy sputum AMS (50%)
HA, GI sx, insomnia, dizziness, lassitude/fatigue

*Can develop more precipitously in children

Hypoxia, tachycardia, crackles Elevated white count CXR: patchy infiltrates, nl heart, full pulmonary arteries

DDx
Pneumonia Acute heart failure Bronchitis Asthma PE MI

Treatment
Oxygen Rest and warmth Descent Hyperbaric chambers Positive pressure Nifedipine (Rx and ppx) Sildenafil (ppx)