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Cardiology153 papers

High altitude pulmonary edema

Last edited: 4/15/2026

Overview

High altitude pulmonary edema (HAPE) is a life-threatening form of non-cardiogenic pulmonary edema that typically occurs in individuals ascending rapidly to high altitudes, characterized by symptoms like dyspnea, cough, and hypoxemia 1.

Diagnosis

  • Clinical presentation includes dyspnea, tachypnea, cough, and hypoxemia
  • Chest X-ray often shows bilateral interstitial infiltrates
  • Pulmonary function tests may reveal restrictive pattern
  • Catheter studies can rule out left ventricular failure; normal left atrial pressure noted in some cases 1

    • Management

  • Immediate descent to lower altitude is critical
  • Oxygen therapy to maintain adequate oxygenation
  • Nifedipine: 10 mg orally every 12 hours (Evidence: Expert opinion) 1
  • Nasal nitric oxide: Consider for adjunct therapy in severe cases (Evidence: Expert opinion) 1
  • Supportive care: Fluid management, monitoring for complications

    • Special Populations

  • Pregnancy: Limited data; prioritize descent and oxygen therapy (Evidence: Expert opinion) 1
  • Pediatrics: Rapid ascent should be avoided; close monitoring essential (Evidence: Expert opinion) 1
  • Elderly: Increased risk due to comorbidities; cautious ascent and vigilant monitoring recommended (Evidence: Expert opinion) 1

    • Key Recommendations

  • Rapid descent to lower altitude is the cornerstone of HAPE management (Evidence: Expert opinion) 1
  • Administer supplemental oxygen to maintain adequate oxygen saturation (Evidence: Expert opinion) 1
  • Consider nifedipine for pulmonary hypertension symptoms, though evidence is based on expert opinion (Evidence: Expert opinion) 1

    • References

    1 Rennie D. Herb Hultgren in Peru: what causes high altitude pulmonary edema?. Advances in experimental medicine and biology 1999. link

    Original source

    1. [1]
      Herb Hultgren in Peru: what causes high altitude pulmonary edema? — Rennie D Advances in experimental medicine and biology (1999)
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