High-Altitude Pulmonary Edema Clinical Presentation

  • Author: Rohit Goyal, MD; Chief Editor: Zab Mosenifar, MD   more...
 
Updated: Jan 18, 2012
 

History

  • High-altitude pulmonary edema (HAPE) generally occurs 1-4 days after rapid ascent to altitudes in excess of 2500 m (8000 ft). Young people and previously acclimatized people reascending to a high altitude following a short stay at low altitude seem more predisposed to HAPE. Cold weather and physical exertion at high altitude are other predisposing factors.
  • The earliest indications are decreased exercise tolerance and slow recovery from exercise.
  • The person usually notices fatigue, weakness, and dyspnea on exertion.
  • The condition typically worsens at night, and tachycardia and tachypnea occur at rest. Periodic breathing during sleep is almost universal in sojourners at high altitude.
  • Cough, frothy sputum, cyanosis, rales, and dyspnea progressing to severe respiratory distress are symptoms of the disease.
  • A low-grade fever, respiratory alkalosis, and leukocytosis are other common features.
  • In severe cases, an altered mental status, hypotension, and death may result.
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Physical

In addition to the symptoms discussed, high-altitude pulmonary edema (HAPE) is diagnosed by the presence of at least 2 of the following signs:

  • Tachycardia
  • Tachypnea
  • Crackles on auscultation
  • Central cyanosis
  • Disproportionately low oxygen saturation relative to altitude
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Causes

  • Rapid ascent
  • Physical exertion at high altitude
  • Exposure to cold
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Contributor Information and Disclosures
Author

Rohit Goyal, MD  Fellow, Division of Pulmonary Medicine, Lenox Hill Hospital, New York University School of Medicine

Rohit Goyal, MD is a member of the following medical societies: American College of Chest Physicians, American Medical Association, and American Thoracic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Mir Omar Ali, MD  Fellow, Department of Pulmonary Medicine, Lenox Hill Hospital, New York University

Mir Omar Ali, MD is a member of the following medical societies: American College of Physicians and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Samia Qazi, MD  Director of the Travel and Immunization Clinic, Nassau County Medical Center; Assistant Professor, Department of Internal Medicine, State University of New York Health Science Center at Stony Brook

Samia Qazi, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine

Disclosure: Nothing to disclose.

Laurie Ward, MD  Chief, Co-Director of Travel and Immunization Clinic, Nassau County Medical Center; Assistant Professor, Department of Internal Medicine, Division of Primary Care, State University of New York at Stony Brook

Laurie Ward, MD is a member of the following medical societies: American College of Physicians, American Society of Nephrology, International Society of Nephrology, and National Kidney Foundation

Disclosure: Nothing to disclose.

Qazi Qaisar Afzal, MD  Clinical Instructor, Department of Medicine, State University of New York at Stony Brook

Qazi Qaisar Afzal, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Mir Mustafa Ali  Deccan College of Medical Sciences, Owaisi Hospital and Research Center, Princess Esra Hospital, India

Disclosure: Nothing to disclose.

Klaus-Dieter Lessnau, MD, FCCP  Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Gregory Tino, MD  Director of Pulmonary Outpatient Practices, Associate Professor, Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Medical Center and Hospital

Gregory Tino, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St Louis University School of Medicine

Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD  Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Professor and Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society

Disclosure: Nothing to disclose.

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