Variables Influencing the Pressure and Volume of the Pulmonary Circulation as Risk Factors for Developing High Altitude Pulmonary Edema (HAPE)

Nina Hundt, Christian Apel, Daniela Bertsch, Carina Cerfontaine, Michael van der Giet, Simone van der Giet, Maren Graß, Miriam Haunolder, Nikole M. Heussen, Julia Jäger, Christian Kühn, Audry Morrison, Sonja Museo, Lisa Timmermann, Knut Wernitz, Ulf Gieseler and Thomas Küpper ()
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Nina Hundt: Institute of Occupational & Social Medicine, RWTH Aachen Technical University, 52074 Aachen, Germany
Christian Apel: Department of Operative Dentistry, Periodontology & Preventive Dentistry, RWTH Aachen Technical University, 52074 Aachen, Germany
Daniela Bertsch: Department of Cardiology, Catholic Hospital Marienhof, 52074 Koblenz, Germany
Carina Cerfontaine: Institute of Occupational & Social Medicine, RWTH Aachen Technical University, 52074 Aachen, Germany
Michael van der Giet: Institute of Occupational & Social Medicine, RWTH Aachen Technical University, 52074 Aachen, Germany
Simone van der Giet: Institute of Occupational & Social Medicine, RWTH Aachen Technical University, 52074 Aachen, Germany
Maren Graß: Institute of Occupational & Social Medicine, RWTH Aachen Technical University, 52074 Aachen, Germany
Miriam Haunolder: Institute of Occupational & Social Medicine, RWTH Aachen Technical University, 52074 Aachen, Germany
Nikole M. Heussen: Department of Medical Statistics, RWTH Aachen Technical University, 52074 Aachen, Germany
Julia Jäger: Institute of Occupational & Social Medicine, RWTH Aachen Technical University, 52074 Aachen, Germany
Christian Kühn: Institute of Occupational & Social Medicine, RWTH Aachen Technical University, 52074 Aachen, Germany
Audry Morrison: Medical Commission of the Union Internationale des Associations d’Alpinisme (UIAA MedCom), CH-3000 Bern, Switzerland
Sonja Museo: Institute of Occupational & Social Medicine, RWTH Aachen Technical University, 52074 Aachen, Germany
Lisa Timmermann: Institute of Occupational & Social Medicine, RWTH Aachen Technical University, 52074 Aachen, Germany
Knut Wernitz: Department of Operative Dentistry, Periodontology & Preventive Dentistry, RWTH Aachen Technical University, 52074 Aachen, Germany
Ulf Gieseler: Medical Commission of the Union Internationale des Associations d’Alpinisme (UIAA MedCom), CH-3000 Bern, Switzerland
Thomas Küpper: Institute of Occupational & Social Medicine, RWTH Aachen Technical University, 52074 Aachen, Germany

IJERPH, 2022, vol. 19, issue 21, 1-10

Abstract: Background: At altitudes above 2500 m, the risk of developing high altitude pulmonary edema (HAPE) grows with the increases in pulmonary arterial pressure. HAPE is characterized by severe pulmonary hypertension, though the incidence and relevance of individual risk factors are not yet predictable. However, the systolic pulmonary pressure (SPAP) and peak in tricuspid regurgitation velocity (TVR) are crucial factors when diagnosing pulmonary hypertension by echocardiography. Methods: The SPAP and TVR of 27 trekkers aged 20–65 years en route to the Solu Khumbu region of Nepal were assessed. Echocardiograph measurements were performed at Lukla (2860 m), Gorak Shep (5170 m), and the summit of Kala Patthar (5675 m). The altitude profile and the participants’ characteristics were also compiled for correlation with the measured data. Results: The results showed a highly significant increase in SPAP and TVR after ascending Kala Patthar. The study revealed a lower increase of SPAP and TVR in the group of older participants, although the respective initial measurements at Gorak Shep were significantly higher for this group. A similar finding occurred in those using Diamox ® as prophylaxis. There was an inverse relationship between TVR and SPAP, the peripheral capillary oxygen saturation, and heart rate. Conclusions: The echocardiograph results indicated that older people are an at-risk group for developing HAPE. A conservative interpretation of the basic tactical rules for altitudes should be followed for older trekkers or trekkers with known problems of altitude acclimatization (“slow acclimatizer”) as SPAP elevates with age. The prophylactic use of Acetazolamide (Diamox ® ) should be avoided where not necessary for acute medical reasons. Acetazolamide leads to an increase of SPAP, and this may potentially enhance the risk of developing HAPE. Arterial oxygen saturation measurements can provide an indicator for the self-assessment for the risk of developing HAPE and a rule of thumb for the altitude profile, but does not replace a HAPE diagnosis. Backpack weight, sex, workload (actual ascent speed), and pre-existing diseases were not statistically significant factors related to SPAP and TVR ( p ≤ 0.05).

Keywords: HAPE; risk factors; echocardiography; pulmonary pressure; workload (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
References: View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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