Vargas P., Enrique, and Hilde Spielvogel. Chronic mountain sickness, optimal hemoglobin, and
heart disease. High Alt. Med. Biol. 7:138–149, 2006.—For the male inhabitants of La Paz, Bolivia
(3200–4100 m), and other high altitude regions in America and Asia, chronic mountain sickness
(CMS) is a major health problem. Since CMS was first described by Carlos Monge in the Peruvian
Andes in 1925, numerous research papers have been devoted to this topic, but many unanswered
questions still exist with respect to the beginning of the disease and its cause(s). The experience
with CMS has shown that an excessively high hemoglobin concentration is not favorable
for high altitude acclimatization, and the hypothesis of theoretically "optimal” hematocrit and
"optimal” hemoglobin has been made. The calculated optimal hemoglobin concentration of 14.7
g/dL for resting men in the Andes is discussed as theoretical and not applicable in real life. The
most frequent congenital and acquired heart diseases are discussed, such as patent ductus, atrial
septum defect, ventricle septum defect among congenital heart diseases and the still very frequent
rheumatic valve cardiopathies and Chagas disease as acquired cardiopathies. Among the
typical acquired heart diseases of the high altitude dweller, special attention is given to chronic
cor pulmonale as a consequence of severe CMS with pulmonary hypertension.
