Some people do not present AMS on several altitude exposures, however, unexplainably, they may have it occasionally. Several tests have been tried in order to determine who will have AMS, however, none to date are able to achieve with absolute certainty who will get AMS. Some tests include having subjects breathe a hypoxic mixture. Others have created exercise protocols with exposure to hypoxia and some other techniques. However, none have been successful. We have successfully diagnosed and treated patients with AMS of different intensity, over many years of work at high altitude, some having undiscovered pathologies that became evident on exposure to high altitude. For example, interauricular communications, nephropaties, leading to essential hypertension, cardiac arrhythmias, presence of a kidney stone that did not block the urine pathway completely, abnormal arteries in the kidney, secuelae of pulmonary disease with localized fibrosis, relative anemia due to poor bone marrow response, falciform anemia, and many others. However, those that apparently have no evident disease can present severe cases of dehydration, particularly while doing exercise at high altitude. This of course, can be quite debilitating and if pushed beyond rationale can lead to severe complications. Performing a very precise diagnosis is difficult and there is still much to study in order to understand hypoxia thoroughly. One of the explanations for the occasional presence of AMS could be the presence of subclinical viral infections. We live with viruses, and when the virus is not so aggressive and not present in sufficient quantities, the organism has an internal struggle that uses up the energy. If the person ascends a mountain in this condition, his reserve to face hypoxic stress is limited and hence may complications appear. Likewise, if the person prior to the ascent had an different type of food, with unusual spices, or with unusual bacteria, then there is an inflammation of the bowels and the endothelial cells of the gastrointestinal tract particularly at the colon level, that may not be able to absorb water as efficiently as under normal circumstances. This could lead to a more severe case of dehydration and hence AMS. There are probably many other factors which include stress from other psychological difficulties, or even exposure to toxics that are inhaled and produce inflammation in the respiratory tract. Furthermore, those training at high altitude can overdo the exercise efforts, with great willpower, leading to very increased pulmonary artery pressure and hence a dilated right heart. This overcharged effort of the muscle cells in the right heart can give rise to inflammation and microlesions that render the heart mildly insufficient in its capacity for pumping blood. On going higher in a sports competition, the optimal heart function is diminished and hence AMS can appear. This is due to the fact that the Adaptation to High Altitude Formula has not been respected in relation to time, where an adequate and timely increase of red blood cells is essential thereby generating subacute high altitude heart disease.
