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(Circulation. 2007;115:1132-1146.)
© 2007 American Heart Association, Inc.

Heart Disease in Latin America

The Heart and Pulmonary Circulation at High Altitudes

Healthy Highlanders and Chronic Mountain Sickness

Dante Penaloza, MD; Javier Arias-Stella, MD, FRCP

From the Department of Medicine (D.P.) and Department of Pathology (J.A.-S.), Faculty of Medicine; and the High Altitude Research Institute (D.P., J.A.-S.), Faculty of Sciences, University Cayetano Heredia, Lima, Peru.

Correspondence to Dante Penaloza, MD, Av. Velasco Astete 911, Lima 41, Peru. E-mail dpenaloza{at}terra.com.pe

Received March 7, 2006; accepted April 30, 2006.

More than 140 million people worldwide live >2500 m above sea level. Of them, 80 million live in Asia, and 35 million live in the Andean mountains. This latter region has its major population density living above 3500 m. The primary objective of the present study is to review the physiology, pathology, pathogenesis, and clinical features of the heart and pulmonary circulation in healthy highlanders and patients with chronic mountain sickness. A systematic review of worldwide literature was undertaken, beginning with the pioneering work done in the Andes several decades ago. Original articles were analyzed in most cases and English abstracts or translations of articles written in Chinese were reviewed. Pulmonary hypertension in healthy highlanders is related to a delayed postnatal remodeling of the distal pulmonary arterial branches. The magnitude of pulmonary hypertension increases with the altitude level and the degree of exercise. There is reversal of pulmonary hypertension after prolonged residence at sea level. Chronic mountain sickness develops when the capacity for altitude adaptation is lost. These patients have moderate to severe pulmonary hypertension with accentuated hypoxemia and exaggerated polycythemia. The clinical picture of chronic mountain sickness differs from subacute mountain sickness and resembles other chronic altitude diseases described in China and Kyrgyzstan. The heart and pulmonary circulation in healthy highlanders have distinct features in comparison with residents at sea level. Chronic mountain sickness is a public health problem in the Andean mountains and other mountainous regions around the world. Therefore, dissemination of preventive and therapeutic measures is essential.

Key Words: altitude • altitude sickness • hypertension, pulmonary

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