Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ KEY FEATURES +++ ESSENTIALS OF DIAGNOSIS ++ Rapid ascent to altitude over 7200 feet Symptoms and signs of pulmonary edema: breathlessness accompanied by cough, initially dry but later productive of white and then pink frothy sputum Likelihood increased by higher elevations, vigorous physical activity, alcohol consumption, cold exposure, and a history of altitude sickness +++ GENERAL CONSIDERATIONS ++ High-altitude pulmonary edema (HAPE) is potentially life threatening HAPE is a form of noncardiac pulmonary edema that typically affects healthy individuals who ascend rapidly to high altitudes Typically, HAPE appears 2–4 days after arrival at high altitude HAPE rarely occurs below 8000 feet (2440 meters), and most cases occur at > 10,000 feet (3050 meters) The altitude at which one sleeps is as important as the altitude where activity takes place In addition to pulmonary edema, HAPE leads to in situ pulmonary artery thrombosis and right heart strain The pathophysiology of HAPE is poorly understood +++ CLINICAL PRESENTATION +++ SYMPTOMS AND SIGNS ++ Dyspnea, orthopnea, cough, hemoptysis (pink frothy sputum) Chest pressure Headache, fatigue, nausea +++ PHYSICAL EXAM FINDINGS ++ Tachycardia Tachydyspnea Low-grade fever Edema Anoxia, cyanosis Pulmonary rales, wheezes +++ DIFFERENTIAL DIAGNOSIS ++ Acute myocardial infarction Exacerbation of preexisting heart condition Pulmonary embolus Pneumonia +++ DIAGNOSTIC EVALUATION +++ LABORATORY TESTS ++ Increased hematocrit +++ ELECTROCARDIOGRAPHY ++ Acute right heart strain pattern +++ IMAGING STUDIES ++ Chest x-ray: pulmonary congestion with normal heart size Echocardiogram: right heart enlargement with Doppler evidence of pulmonary hypertension +++ TREATMENT +++ CARDIOLOGY REFERRAL ++ Suspected coronary artery disease +++ HOSPITALIZATION CRITERIA ++ All patients with HAPE +++ MEDICATIONS ++ Descend to a lower altitude as soon as possible Supplemental oxygen (2–4 L/min) Nifedipine 20 mg every 8 hours to lower pulmonary pressure Nitric oxide inhalation (40 ppm) +++ THERAPEUTIC PROCEDURES ++ Hyperbaric pressure bag +++ MONITORING ++ ECG in hospital +++ DIET AND ACTIVITY ++ Low-sodium diet Restrict activity +++ ONGOING MANAGEMENT +++ HOSPITAL DISCHARGE CRITERIA ++ Resolution of HAPE +++ FOLLOW-UP ++ None necessary because cardiac function is usually normal +++ COMPLICATIONS ++ Death High-altitude cerebral edema Hypotension Pulmonary emboli Arrhythmias +++ PROGNOSIS ++ Excellent with prompt, effective treatment +++ PREVENTION ++ Avoid exertion for 24 hours Avoid alcohol for 24 ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.