High-Altitude Pulmonary Edema Clinical Presentation

Updated: Dec 31, 2015
  • Author: Rohit Goyal, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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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.



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

  • Tachycardia

  • Tachypnea

  • Crackles on auscultation

  • Central cyanosis

  • Disproportionately low oxygen saturation relative to altitude



Causes are as follows:

  • Rapid ascent

  • Physical exertion at high altitude

  • Exposure to cold