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MOUNTAIN DISEASE

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MOUNTAIN DISEASE - a pathological condition that develops due to the low partial pressure of atmospheric gases, mainly oxygen, in high altitude conditions. There are acute, subacute and chronic forms of mountain sickness. The first two forms at altitudes from 2500 to 4000 m are recorded at 10 - 20%, and above 4500 m - almost all ascending to the mountains. Chronic mountain sickness develops among mountain natives (at altitudes usually more than 3000 m) and is noticeably less common.

Low partial pressure of oxygen in the atmosphere disrupts gas exchange, causes tissue hypoxia, which leads to impaired function of organs, including the brain, increased permeability of vascular membranes, changes in water-electrolyte balance With a delay in the body fluid.

The clinical picture of acute and subacute forms of mountain sickness is basically similar, but in the acute form, the symptoms of the disease grow rapidly (patients may need emergency care), and in the case of subacute, gradually and persist for a relatively long time (more than 7-10 days). Headaches, nausea , sometimes vomiting , fatigue, shortness of breath , palpitations, flatulence are noted. Patients are apathetic (sometimes excited), sleep poorly (intermittent sleep, restless). Diffuse cyanosis , an increase in the frequency and depth of respiration, increased heart rate, and a decrease in blood pressure are observed. At an altitude of 5000 m, there may be a loss of consciousness. On the ECG, the deviation of the electric axis to the right, smoothness or inversion of the T wave. In the blood, erythrocytosis, hyperhemoglobinemia, and a decrease in reserve alkalinity are determined.

As independent forms of alpine pathology, high-altitude acute pulmonary edema and high-altitude acute cerebral edema are distinguished. The first occurs 1–4 days after a rapid rise to a height of more than 2700 m and is manifested initially by headache and increasing shortness of breath in the form of tachypnea (“breath of a driven dog”), accompanied by coughing, then the appearance of bloody foamy sputum, bubbling breath. On examination, cyanosis of the lips is detected, tachycardia is noted, in the lungs - wet small and medium bubbling rales . A coma may develop in a few hours. Body temperature is normal or low-grade; in the blood - moderate leukocytosis , a slight increase in ESR. Alpine acute cerebral edema is manifested by an increasing headache, impaired gait, dizziness and hallucinations, nausea, vomiting, oliguria, shortness of breath and palpitations, depression, then inhibition, followed by coma.

Chronic mountain sickness develops gradually and is manifested by a decrease in working capacity, shortness of breath, cough (sometimes hemoptysis), dizziness, and fainting. The face of patients acquires a cherry-cyanotic color. Often “drum fingers” come to light. The pulse is quickened, the borders of the heart are extended to the right. Polycythemia is detected in a blood test. The most common complications are congestive heart failure , heart rhythm disturbances, thromboembolism.

Treatment for acute mountain sickness of a mild degree is usually not required; in severe mountain sickness, treatment is started on the spot with immediate oxygen therapy, and in case of high altitude acute cerebral or pulmonary edema, also with the intravenous administration of small doses of fast-acting diuretics (2 mg furosemide) and diacarb inside (250 mg every 4 hours), use calcium antagonists (nifedipine) to reduce pressure in the pulmonary arteries, and glucocorticoids (dexamethasone) for cerebral edema; if necessary, suck the secret from the trachea and bronchi; patients are urgently evacuated in areas located below 2000 m. With moderate severity of mountain sickness, the amount of fluid taken, sodium chloride and the use of foods that contribute to flatulence are limited. Recommended breathing exercises (with a moderate increase in exhalation resistance), if necessary - oxygen inhalation. If the symptoms of mountain sickness do not regress in the next 3 days, further stay in the mountains is contraindicated. In chronic mountain sickness with pulmonary hypertension, calcium antagonists are used, and in case of congestive failure diuretics are used.

Prevention of acute mountain sickness consists in medical selection of people sent to the mountains, their preliminary physical preparation, special training in hypobaric pressure chambers. A gradual (stepped) ascent to the mountains and the restriction of physical activity are recommended, which improves alpine adaptation.