Document Detail


New insights in the pathogenesis of high-altitude pulmonary edema.
MedLine Citation:
PMID:  20417341     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
High-altitude pulmonary edema is a life-threatening condition occurring in predisposed but otherwise healthy individuals. It therefore permits the study of underlying mechanisms of pulmonary edema in the absence of confounding factors such as coexisting cardiovascular or pulmonary disease, and/or drug therapy. There is evidence that some degree of asymptomatic alveolar fluid accumulation may represent a normal phenomenon in healthy humans shortly after arrival at high altitude. Two fundamental mechanisms then determine whether this fluid accumulation is cleared or whether it progresses to HAPE: the quantity of liquid escaping from the pulmonary vasculature and the rate of its clearance by the alveolar respiratory epithelium. The former is directly related to the degree of hypoxia-induced pulmonary hypertension, whereas the latter is determined by the alveolar epithelial sodium transport. Here, we will review evidence that, in HAPE-prone subjects, impaired pulmonary endothelial and epithelial NO synthesis and/or bioavailability may represent a central underlying defect predisposing to exaggerated hypoxic pulmonary vasoconstriction and, in turn, capillary stress failure and alveolar fluid flooding. We will then demonstrate that exaggerated pulmonary hypertension, although possibly a conditio sine qua non, may not always be sufficient to induce HAPE and how defective alveolar fluid clearance may represent a second important pathogenic mechanism.
Authors:
Urs Scherrer; Emrush Rexhaj; Pierre-Yves Jayet; Yves Allemann; Claudio Sartori
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Progress in cardiovascular diseases     Volume:  52     ISSN:  1873-1740     ISO Abbreviation:  Prog Cardiovasc Dis     Publication Date:    2010 May-Jun
Date Detail:
Created Date:  2010-04-26     Completed Date:  2010-05-13     Revised Date:  2013-05-02    
Medline Journal Info:
Nlm Unique ID:  0376442     Medline TA:  Prog Cardiovasc Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  485-92     Citation Subset:  AIM; IM    
Affiliation:
Department of Internal Medicine and the Botnar Center for Extreme Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. urs.scherrer@chuv.ch <urs.scherrer@chuv.ch>
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MeSH Terms
Descriptor/Qualifier:
Altitude
Altitude Sickness / complications*,  physiopathology
Endothelin-1 / metabolism
Foramen Ovale, Patent / complications
Humans
Hypertension, Pulmonary / complications*,  physiopathology
Mountaineering*
Nitric Oxide / biosynthesis
Pulmonary Alveoli / metabolism,  physiopathology
Pulmonary Circulation*
Pulmonary Edema / etiology*,  physiopathology
Respiratory Mucosa / metabolism,  physiopathology
Risk Factors
Sodium / metabolism
Sympathetic Nervous System / physiopathology
Vasoconstriction
Chemical
Reg. No./Substance:
0/Endothelin-1; 10102-43-9/Nitric Oxide; 7440-23-5/Sodium

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