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Hypoxia/Hypoxemia stimulate the cardiovascular system to adapt in order to maintain a sufficient oxygenation of
the tissues
Adaptation
• Erythrocytosis
Adaptation to altitude
• Increased affinit
oxygen-hemoglobin
• Pulmonary
vasoconstriction, cerebral
vasodilation
• Increased ventilation
and cardiac output
Adaptation and acclimatization
Interindividual variability
Rimoldi, Sartori et al Prog Cardiovasc Dis 2010;52:512-24
visual sensitivity
personnality trait
manual ability
balance
reaction time
decision making
judgment
behavior
character
affect
orientation
memory
concentration
Alterations observed at 2500 m
sense of reality
mood, impulse control
hearing sensitivity
What may happen?
1.AMS – acute mountain sickness
2.HACE – high altitude cerebral edema
3.HAPE – high altitude pulmonary edema
4.Re-Entry HAPE – high altitude residents HAPE
5.CMS – Chronic Mountain sickness (Monge)
What may happen?
1.AMS – acute mountain sickness
2.HACE – high altitude cerebral edema
3.HAPE – high altitude pulmonary edema
AMS HACE HAPE
Irritability
Headache
Anorexia
Dizziness
Nausea, vomiting
Sleep disturbances
Asthenia
Severe Headache
Ataxia
Coordinationdisturbances
Consciousness
Loss of focal neurologicfunctions
Dyspnea
Tachypnea
Tachycardia
Dry or productivecough
AMS Incidence
Children and Adolescents 22% to 27%
Adults 48% to 62%
Bloch J, Duplain H, Rimoldi SF, et al. Prevalence and time course of acute mountain sickness in older children and adolescents after rapid ascent to 3450meters. Pediatrics 2009;123:1-5.
Rexhaj E, Garcin S, Rimoldi SF, et al. Reproducibility of acute mountain sickness in children and adults : A prospective study. Pediatrics2011;127:e1445-8.
Duplain H, Sartori C, Scherrer U. Maladies de haute altitude. Rev Med Suisse 2007;3:1766-9.
Das BB, Wolfe RR, Chan KC, et al. High-altitudepulmonary edema in children with underlying cardiopulmonary disorders and pulmonary hypertension living at altitude. Arch Pediatr Adolesc Med 2004;158:1170-6.
Sartori C, Allemann Y, Trueb L, et al. Exaggeratedpulmonary hypertension is not sufficient to trigger high altitudepulmonary oedema in humans. Schweiz MedWochenschr 2000;130:385-9.
Exagerated pulmonary arterial hypertension is not sufficient totrigger pulmonary oedema in humans
Trisomy 21
0
5
10
15
20
25
30
35
40
1
P < 0.05
Environmental insults occurring during the fetal / perinatal period
Low birth weight
Augmented risk of cardiovascular diseases in adulthood
Coronary heart disease, Hypertension, Diabetes
The Barker hypothesis Developmental origin of adult diseases
Systemic vascular dysfunction
Low altitude High altitude (4559 m)
Pulmonary artery pressure(mm Hg)
Transient perinatal hypoxia predisposes to exaggerated hypoxic pulmonary hypertension later in life
76
48
20
Sartori et al, Lancet 1999;353:2205-07
Transient perinatal hypoxia
Controls
0
25
50
75
100
Offspring of preeclampsia, a novel risk factor for hypoxic pulmonary hypertension?