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Published on: March 8, 2019
Pulmonary hypertension and chronic mountain sickness
Robert Naeije1, Rebecca Vanderpool
1Department of Pathophysiology, Faculty of Medicine, Free University of Brussels, 808 Lennik Rd., Brussels, Belgium. rnaeije@ulb.ac.be
Chronic mountain sickness, characterized by high red blood cell counts and low oxygen, can lead to pulmonary hypertension. Acetazolamide treatment improves key indicators of this altitude-related condition.
Area of Science:
- Cardiovascular Physiology
- Altitude Medicine
- Respiratory Physiology
Background:
- Chronic mountain sickness (CMS) is a condition affecting high-altitude dwellers, marked by excessive red blood cells (polycythemia) and low oxygen levels (hypoxemia).
- Pulmonary hypertension (PH) can develop in CMS, linked to reduced oxygenation and vascular changes in the lungs.
- Exercise responses in CMS patients show abnormal pulmonary artery pressure dynamics.
Purpose of the Study:
- To investigate the characteristics of pulmonary hypertension in chronic mountain sickness.
- To evaluate the impact of exercise on pulmonary hemodynamics in CMS patients.
- To assess the efficacy of acetazolamide in managing CMS and its associated complications.
Main Methods:
- Analysis of pulmonary artery pressure-flow relationships during exercise.
- Assessment of vascular distensibility and pulmonary vascular resistance.
- Evaluation of hematocrit's influence on pulmonary hypertension severity.
- Clinical trial of acetazolamide treatment over six months.
Main Results:
- Pulmonary hypertension in CMS is proportional to decreased oxygenation, suggesting hypoxic vasoconstriction.
- Exercise reveals steep pulmonary artery pressure-flow slopes and reduced vascular distensibility.
- Correcting for hematocrit lessens the severity of pulmonary hypertension.
- Exercise capacity is maintained in CMS despite PH, due to high blood oxygen content and lung diffusing capacity.
- Acetazolamide treatment significantly improved oxygenation, polycythemia, and pulmonary artery pressure over six months.
Conclusions:
- Pulmonary hypertension in CMS is primarily driven by hypoxia and hematocrit.
- Exercise capacity is preserved in CMS patients despite pulmonary vascular abnormalities.
- Acetazolamide is an effective treatment for improving key physiological markers in chronic mountain sickness.
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