A new case report recently published in Frontiers in Medicine, highlights 2 previously healthy young men with normal cardiopulmonary function who developed high-altitude pulmonary hypertension (HAPH) after moving to high altitudes above 4,300 meters.
In Case 1, a 21-year-old male, after living at an altitude of 4,800 meters for 4 months, developed progressively worsening chest pain, shortness of breath, and amaurosis fugax. While in Case 2, a 20-year-old male, after 18 months of residence at 4,300 meters, experienced exertional dyspnea accompanied by amaurosis fugax and a brief loss of consciousness.
Diagnostic Findings
According to the report, physical examination showed hypoxemia (oxygen saturation 80 and 82% on room air, respectively). The report also showed that echocardiography in both cases demonstrated right atrial and right ventricular enlargement, moderate tricuspid regurgitation, with estimated systolic pulmonary artery pressures (sPAP) as high as 55 mmHg and 56 mmHg, respectively. Additionally, chest CT confirmed right heart enlargement and main pulmonary artery dilation. For these patients, HAPH was diagnosed after systematic evaluation excluded other etiologies.
Course of Treatment
“The most fundamental treatment for diagnosed HAPH patients is removal from the high-altitude hypoxic environment, making early recognition and intervention crucial,” the authors of the report stated.
In Case 1, the authors stated the patient’s course of treatment was as follows:
“Patient returned to an area below 1,500 meters within 48 hours and received no pharmacological or other specific interventions. A follow-up transthoracic echocardiogram performed 6 days later showed an estimated sPAP of approximately 47 mmHg and mPAP of 31 mmHg. One month later, repeat echocardiography demonstrated complete normalization of pulmonary artery pressures.”
In Case 2, the authors stated the patient’s course of treatment was as follows:
“Due to occupational constraints, the patient was unable to return to low altitude promptly. During this period, management consisted of daily low-flow oxygen therapy for over 16 hours, strict limitation of physical activity, and primarily bed rest. After 24 days of this regimen, a follow-up echocardiogram was performed. Mild progression of right heart enlargement, characterized by increased dimensions of the right atrium and right ventricle (right ventricular transverse diameter 39 mm; right atrial diameter 46 mm). The estimated sPAP was approximately 47 mmHg, and the calculated mPAP was 31 mmHg.”
What was noteworthy, the authors pointed out, is the clinical courses of the 2 patients diverged significantly. For example, they said, “transfer to a low-altitude environment without any targeted intervention, the sPAP in Case 1 gradually decreased and normalized within 1 month. In contrast, despite prolonged oxygen therapy and strict bed rest at high altitude, Case 2 showed no significant reduction in sPAP, and right heart enlargement persisted.”
The study concluded that high-altitude environments can significantly pose a threat to the cardiovascular systems of susceptible individuals. For patients who have lived at high altitude and present with related symptoms, the authors stressed that clinicians should maintain a high index of suspicion for HAPH and perform prompt screening and diagnosis to prevent adverse outcomes.
Source: Frontiers in Medicine