Syndromes of subacute mountain sickness

Two clinical syndromes, acute and chronic mountain sickness, have traditionally been associated with high altitude. Recently, two separate entities of subacute nature have been described in infants and adults. In this paper, we review the published literature on these conditions. Subacute infantile mountain sickness is a condition seen predominantly in Han Chinese infants living in Tibet, although it has been described in other high altitude communities as well. It came into prominence only after the large-scale migration of Chinese population from the low altitude of mainland China to the high altitudes of the Qinghai-Tibetan plateau. The condition is characterized by features of severe hypoxic pulmonary hypertension and heart failure. Pulmonary histology is consistent with muscularization of the pulmonary arterioles, but no intimal proliferation or plexiform lesions are seen. The second syndrome, adult subacute mountain sickness, has been described almost exclusively in Indian soldiers living at extreme altitude for prolonged periods of time. In this condition also, hypoxic pulmonary hypertension appears to be the dominant factor responsible for severe congestive heart failure. Both these conditions have several similarities with brisket disease in cattle; hypoxic pulmonary vasoconstriction plays an important role in the pathogenesis, and removal from high altitude results in complete resolution. Thus, it appears that both these syndromes are human counterparts of brisket disease in cattle.