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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 altitude sickness. The first two forms at altitudes from 2500 to 4000 m are recorded in 10–20%, and above 4500 m - in almost all those ascending into the mountains. Chronic mountain sickness develops in the aboriginal mountains (at altitudes usually more than 3000 m) and is much less common.

The low partial pressure of oxygen in the atmosphere disrupts gas exchange, causes tissue hypoxia, which leads to disruption of the function of organs, including the brain, increased permeability of vascular membranes, changes in water and electrolyte balance With fluid retention in the body.

The clinical picture of the acute and subacute forms of altitude sickness is mostly similar, but in the acute form the symptoms of the disease increase rapidly (patients may need emergency care), and in the subacute they 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 agitated), sleep poorly (intermittent, restless sleep). Observed diffuse cyanosis , an increase in the frequency and depth of breathing, increased heart rate, lower blood pressure. At an altitude of 5000 m there may be a loss of consciousness. On the ECG, the deviation of the electrical axis to the right, the flatness or inversion of the T wave. In the blood, erythrocytosis, hyperhemoglobinemia, decrease in reserve alkalinity are determined.

As independent forms of alpine pathology, high-altitude acute pulmonary edema and high-altitude acute brain edema are distinguished. The first occurs 1–4 days after a rapid ascent to a height of more than 2,700 m and manifests itself first with headache and increasing dyspnea of ​​the tachypnea type (“tired dog breathing”), accompanied by coughing, then the appearance of bloody foamy sputum and bubbling breathing. On examination, cyanosis of the lips is detected, tachycardia is noted, and in the lungs - moist small and medium bubbly rales . A coma may develop in a few hours. Body temperature is normal or low-grade; blood - moderate leukocytosis , a slight increase in ESR. High-altitude acute cerebral edema is manifested by increasing headache, gait disturbance, stupefaction and hallucinations, nausea, vomiting, oliguria, shortness of breath and palpitations, depression, then inhibition, alternating with a coma.

Chronic altitude sickness develops gradually and is manifested by decreased performance, shortness of breath, cough (sometimes hemoptysis), dizziness, fainting. The face of the patients becomes cherry-cyanotic in color. Often revealed "drum fingers." Pulse is speeded up, borders of heart are expanded to the right. In the blood test revealed polycythemia . The most frequent complications are congestive heart failure , cardiac arrhythmias, thromboembolism.

Treatment for mild acute mountain disease, as a rule, is not required; in case of severe mountain sickness, treatment begins on the spot with immediate oxygen therapy, and in case of high-mountainous acute edema of the brain or lungs, also with intravenous administration of small doses of fast-acting diuretics (2 mg furosemide) and oral diacarb administration (250 mg every 4 hours), use pressure-reducing calcium antagonists in the pulmonary arteries (nifedipine), and in case of cerebral edema - glucocorticoids (dexamethasone); if necessary, suck the secret of the trachea and bronchi; patients are urgently evacuated to areas located below 2,000 m. With moderate mountain sickness, they limit the amount of fluids taken, table salt, and the use of foods that promote meteorism. Breathing exercises are recommended (with a moderate increase in resistance to exhalation), 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 disease with pulmonary hypertension, calcium antagonists are used, and in case of congestive failure, diuretics are used.

Prevention of acute mountain sickness lies in the medical selection of individuals sent to the mountains, their prior physical training, and special training in hypobaric pressure chambers. Gradual (stepwise) ascent into the mountains and limitation of physical exertion is recommended, which improves alpine adaptation.