Background

During the VI World Congress on Mountain Medicine and High Altitude Physiology, which was held in Xining, Qinghai, China in 2004, a Consensus Statement on Chronic and Subacute High Altitude Diseases was achieved by an ad hoc committee of the International Society for Mountain Medicine (ISMM). The Consensus Statement was published in 2005 and in the introduction to this document, a cautious warning was included on the possible evolution of this consensus as result of further research [26].

The Consensus recognizes two main groups of chronic and subacute high altitude diseases. A) Chronic Mountain Sickness (CMS) or Monge's

Figure 4. A, Pathogenesis of CMS. Development of alveolar hypoventilation in life-long residents at HA induces severe hypoxemia, exaggerated polycythemia and neuropsychic symptoms. There is moderate or severe PH and some cases evolve to hypoxic cor pulmonale and HF. B, Pathogenesis of SMS. In some infant newcomers to HA there is an excessive amount of SMC in the distal pulmonary arterial branches and exaggerated vasoconstriction, which induces severe PH, hypertensive cor pulmonale and HF. Hypoxemia and polycythemia of mild degree are found in these cases. HF indicates heart failure. Reproduced from Penaloza and Arias-Stella [46].

Figure 4. A, Pathogenesis of CMS. Development of alveolar hypoventilation in life-long residents at HA induces severe hypoxemia, exaggerated polycythemia and neuropsychic symptoms. There is moderate or severe PH and some cases evolve to hypoxic cor pulmonale and HF. B, Pathogenesis of SMS. In some infant newcomers to HA there is an excessive amount of SMC in the distal pulmonary arterial branches and exaggerated vasoconstriction, which induces severe PH, hypertensive cor pulmonale and HF. Hypoxemia and polycythemia of mild degree are found in these cases. HF indicates heart failure. Reproduced from Penaloza and Arias-Stella [46].

disease and B) High Altitude Pulmonary Hypertension (HAPH), which includes several entities: 1) High Altitude Heart Disease (HAHD) of adult chronic type, described in China, 2) High Altitude Cor Pulmonale (HACP) described in Kyrgyzstan, and 3) Subacute Mountain Sickness (SMS), also named subacute High Altitude Heart Disease (subacute HAHD) of infantile and adult types.

The main rationale for this classification was the assumption of definite PH in diseases of group B in contrast to CMS. This assumption motivated us to carry out a review of world-wide literature of hemodynamic studies on high altitude diseases with the exclusion of High Altitude Pulmonary Edema (HAPE), an acute HA disease characterized by excessive PH, which has a well-known role as an initiating factor of this entity. In addition, and for comparative purposes, we reviewed the hemodynamic studies undertaken in healthy highlanders at different altitudes. Before discussing our findings, it is important to clarify the notion of normal PAP values at sea level and consequently the definition of PH.

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