High-altitude Pulmonary Edema in Emergency Department: A Review

High altitude pulmonary Edema (HAPE) is a severe form of high-altitude disease that, if left untreated, can result in death in up to half of those who are affected. Lowlanders who rapidly go to elevations more than 2500-3000 m are more likely to develop high altitude pulmonary Edema (HAPE). Individual sensitivity owing to a low hypoxic ventilatory response (HVR), quick pace of climb, male sex, usage of sleep medicine, high salt consumption, chilly ambient temperature, and intense physical effort are all risk factors. HAPE may be totally and quickly reversed if caught early and correctly treated. Slow climb is the most effective technique of prevention. A fall of at least 1000 meters, is the best and most certain treatment choice in HAPE. Supplemental oxygen, portable hyperbaric chambers, and pulmonary vasodilator medications (nifedipine and phosphodiesterase-5 inhibitors) may be beneficial. In this article we’ll be looking at the disease etiology, epidemiology, diagnosis and management.

283 Heterosis and its potential influence on pulmonary arterial pressure in beef cattle

High altitude disease (HAD) is a hypoxia-influenced pathologic condition experienced by cattle raised at high elevations (> 1,524 m). Pulmonary arterial pressure (PAP) is a common diagnostic tool used as an indicator of susceptibility to develop HAD. Given PAP is moderately heritable, possibilities to genetically reduce the incidence of HAD are feasible. However, an alternative strategy could be given by heterosis, since non-additive genetic effects have been related to survivability and environmental fitness. Therefore, objectives of this study were to determine heterosis and breed percentage effects on PAP measurements. A total of 1,083 cattle with varying percentages of Simmental, Angus, Hereford and Red Angus breeds were used for the study. Such animals’ available information included PAP records, PAP test date, PAP technician, sex, herd of origin and breed percentages of parents. A general linear model was utilized to estimate the effect of heterosis on PAP. Contemporary group (defined as a combination between herd, PAP date, PAP technician and sex) was included as a categorical fixed effect; whereas the age at PAP measurement and the degree of outcross were included as linear covariates. Similarly, breed effects were estimated by including breed percentages of Simmental, Angus, Hereford, Red Angus and “Other” breeds as linear covariates in the model. The general average for PAP measurements in the entire dataset was 41.29 ± 0.22, with range of 26 and 108 mmHg. The estimated regression coefficient for PAP on heterosis was -1.834 ± 1.676 mmHg/percent of outcross (P = 0.276), whereas, the range of breed effects on PAP was 15.08 mmHg. These results suggested that heterosis had no significant effects on PAP measurements. However, further research including other multibreed populations is required in order to better understand if increased levels of heterozygosity could potentially be related to lower PAP scores.

PSI-32 Effect of pulmonary arterial pressure on reproductive performance in Angus heifers located in south central Wyoming

Pulmonary hypertension (i.e., high altitude disease) occurs in locations above 1,600 m in elevation and causes heart failure and death. Pulmonary arterial pressure scoring is an effective indicator of pulmonary hypertension and high-altitude disease. The objective of this study was to look at the effect of pulmonary arterial pressure (PAP) scoring on reproductive performance in Angus heifers. First service conception (FSC), pregnancy rate, and pulmonary arterial pressure scores were obtained from the Colorado State University Beef Improvement Center for 2,503 Angus heifers between 1995 and 2016. All spring-calving females were exposed to estrous synchronization and one-round of artificial insemination. After a 10-d holding period heifers were exposed to natural service sires for 60 days. First service conception and pregnancy rate traits were determined using ultrasonography via rectal palpation at 30 and 60 days post artificial insemination. Pulmonary arterial pressure scores were collected at ~12 mos of age. Data were analyzed with ANOVA as a completely randomized block design, blocking by birth year. Fixed effect was pulmonary arterial pressure group [high (>42mm Hg) vs. low (<42 mmHg)]. Logistic regression was used to further investigate fertility traits with PAP scores. Nodifferences were detected among pulmonary arterial pressure group for first service conception (P > 0.05); however, high pulmonary arterial pressure heifers had lower pregnancy rates compared to low PAP heifers (0.86 vs. 0.91 ± 0.01; P = 0.03). Logistic regression supported these findings, identifying PAP score as a significant predictor of breeding season pregnancy rate (P < 0.05), indicating an inverse relationship between PAP score and pregnancy rate. Cumulatively, results show an unfavorable relationship between heifers with high pulmonary arterial pressure scores and overall pregnancy rate.

High-altitude pulmonary oedema

At high altitude, the reduction in arterial oxygenation frequently leads to symptoms of acute mountain sickness. While these symptoms generally resolve spontaneously, high-altitude pulmonary oedema can develop and represents a potentially lethal form of high-altitude disease. High-altitude pulmonary oedema is a non-cardiogenic oedema due to exaggerated pulmonary vasoconstriction and altered alveolar–capillary permeability. In addition to descending to lower altitude, it requires specific emergency cares such as oxygen administration, a hyperbaric bag, and vasodilator drugs.

Pulmonary hypertension associated with left heart disease and lung disease, high-altitude disease, and chronic thromboembolic pulmonary hypertension

Conditions discussed are hypertension associated with left heart disease and lung disease, and chronic thromboembolic pulmonary hypertension.