New Insights in the Pathogenesis of High-Altitude Pulmonary Edema
Section snippets
Exaggerated hypoxic pulmonary hypertension
Exaggerated pulmonary hypertension is a hallmark of HAPE,4, 5 and several observations indicate that it contributes to its pathogenesis. Anatomical (congenital absence of the right pulmonary artery, pulmonary artery occlusion from granulomatous mediastinitis)6, 7 or functional (Down syndrome)8, 9 abnormalities that facilitate pulmonary hypertension are risk factors for developing HAPE at relatively low altitude (1500-2500 m). Lowering of pulmonary artery pressure with pharmacologic agents of
Conclusion
Based on our results, we suggest the following new concept for the pathogenesis of HAPE (Fig 5). Pulmonary edema results from a persistent imbalance between the forces that drive water into the airspace and the biologic mechanisms for its removal. In HAPE-prone subjects, alveolar fluid flooding is augmented because of exaggerated pulmonary hypertension that appears to be related, at least in part, to defective NO synthesis leading to endothelial dysfunction and exaggerated sympathetic
Statement of Conflict of Interest
All authors declare that there are no conflicts of interest.
Acknowledgments
The authors' research was supported by grants from the Swiss National Science Foundation, the Dr Max Cloëtta Foundation, the Novartis Foundation, the Eagle Foundation, the Leenaards Foundation, and the Placide Nicod Foundation.
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Cited by (95)
Might a high hemoglobin mass be involved in non-cardiogenic pulmonary edema? The case of the chronic maladaptation to high-altitude in the Andes
2021, Medical HypothesesCitation Excerpt :However, this body reaction eventually becomes maladaptive and causes serious clinical manifestations like high-altitude pulmonary edema or HAPE [1], a life-threatening condition caused by a rapid accumulation of extracellular fluid flooding in the pulmonary alveoli [1,3]. Yet the precise origin of HAPE has been attributed to an increase in intrapulmonary arterial pressure [4–7], the putative role of a direct or an indirect pathologic insult [8] has been neglected. The Andes is the region with the highest incidence of HAPE worldwide [9–11].
Research advances in pathogenesis and prophylactic measures of acute high altitude illness
2018, Respiratory Medicine
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