High-Altitude Pulmonary Edema (HAPE) Clinical Presentation

Updated: Apr 07, 2020
  • Author: Rohit Goyal, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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High-altitude pulmonary edema (HAPE) generally occurs 2-4 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, and a dry cough. [7]

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. Patients may also complain of chest tightness or congestion. [18]

Cough, frothy sputum (may be pink or contain frank blood [1] ), cyanosis, rales, and dyspnea progressing to severe respiratory distress are symptoms of the disease. [1, 4]

A low-grade fever, respiratory alkalosis, and leukocytosis are other common features.

In severe cases, an altered mental status, hypotension, and death may result.


Physical Examination

In addition to the symptoms discussed, signs of high-altitude pulmonary edema (HAPE) may include the following signs:

  • Tachycardia

  • Prominent P2 and right-ventricular heave on auscultation/palpation

  • Tachypnea

  • Crackles on auscultation (generally first appreciated in the right mid-lung field [7] )

  • Central cyanosis

  • Productive cough, with pink, frothy sputum or frank blood [1]

  • Disproportionately low oxygen saturation relative to altitude (eg, 10-20 points lower than asymptomatic individuals at the same altitude [7] )