Wo l f g a n g D o m e j , G ü n t h e r S c h w a b e r g e r, Clemens Pietsch, Christoph Guger
Pulmonale Hypertonie und struktureller Gefäßumbau in der Höhe High altitude pulmonary hypertension and vascular remodeling S U M M A RY Acute hypoxia causes vasoconstriction of precapillary pulmonary vessels, mainly arterioles, leading to an increase in pulmonary pressure. In contrast, chronic hypoxia leads to structural alterations such as media smooth muscle hypertrophy and extension of smooth muscles into normally non-muscularized arterial vessels, and intimal fibrosis. Severe pulmonary hypertension at high altitude may afflict high altitude mountaineers and may be followed by high altitude pulmonary edema (HAPE). Individuals with respiratory diseases associated with pulmonary hypertension even at rest at normal altitudes as well as rare cases of unilateral agenesia of a pulmonary artery need very special attention when going to high altitudes. These individuals are per se at high risk for HAPE and acute heart failure of the right ventricle, respectively. According to the impact of pulmonary hypertension in the pathogenesis of HAPE, each severe disease associated with pulmonary hypertension may be a relative contraindication for sojourning at high altitudes, which may aggravate pulmonary hypertension and have severe consequences. Right heart catheterization and simultaneous application of hypoxic gas mixtures may be helpful in the evaluation of the individual’s hypoxic tolerance. Keywords: Acute and chronic pulmonary hypertension, high altitude, pulmonary circulation, hypoxic pulmonary vasoconstriction, pulmonary vascular remodeling.
Z U S A M M E N FA S S U N G Akute Hypoxie führt über eine Vasokonstriktion präkapillärer Pulmonalgefäße, vor allem der Arteriolen, zur Drucksteigerung im Lungenkreislauf. Im Gegensatz dazu zieht chronische Hypoxie strukturelle Änderungen infolge Mediahy-
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