Abstract
To the Editor:
A 60-year-old man started coughing and feeling weak after a night at 3100 m altitude in the Alps, and after continuing ascent, deteriorated quickly to breathlessness during rest, crackling noises whilst breathing, and blue lips and fingernails. His mountain partners suspected high-altitude pulmonary edema (HAPE) and brought him down to the valley immediately, where he recovered within a short time without medical help. The alpinist is an experienced climber who had undertaken numerous mountain tours below 3000 m altitude in the Alps without any medical problems. Because of a heart murmur, transesophageal echocardiography had been performed a few years prior and revealed a patent foramen ovale; no consequences to this finding had been suggested at that time (Figure). Patent foramen ovale is 4 times more frequent in HAPE-susceptible than in HAPE-resistant mountaineers. A large patent foramen ovale contributes to exaggerated arterial hypoxemia and facilitates HAPE. 1
Patent foramen ovale (arrow). LA indicates left atrium; RA, right atrium; and AO, aorta (transesophageal echocardiography).