Dr. H.K. Bali - Cardiologist, Chandigarh

Dr. H.K. Bali

Director Cardioloy, Fortis Mohali

Areas of Expertise: Angioplasty, Coronary Intervention

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Subacute Adult Mountain Sickness

Subacute mountain sickness is a distinct syndrome of congestive cardiac failure seen in lowlanders during a prolonged stay at extremely high altitude (> 5800 meters).
To study the clinical and investigative profile of subacute mountain sickness amongst Indian soldiers stationed at extreme altitude.
Symptomatic individuals who were stationed above 5000 meters were evacuated to 3000 meters and clinically screened for signs of congestive cardiac failure. ECG and X-ray chest; haematological and biochemical parameters were evaluated. Response to rest, oxygen and diuretics were studied and they were evacuated to the plains. They were followed up at the plains for a period of two weeks at the end of which chest X-ray and ECG were repeated.
Eight patients were diagnosed over a period of one month who had classical features of congestive cardiac failure. The mean age was 28.75 years, the mean altitude 5828.47 meters and the mean duration of stay of 17.35 weeks. The most common symptom was exertional dyspnea (6 of 8 cases) and the most common sign of bilateral pedal oedema (7 of 8 cases). Two patients had deep venous thrombosis. Clinical, ECG and X-ray evidence of pulmonary hypertension was seen in seven cases. The mean haemoglobin was 18 gm%. Response to oxygen and diuretics was dramatic. Clinical findings and investigations reverted to normal after two weeks of stay on the plains.
This brief study of subacute mountain sickness reemphasizes the role of pulmonary hypertension as the initiating event. Other factors are salt and water retention and polycythemia. Brisk response to diuretics and oxygen and restoration of normalcy on deduction to the plains establishes the reversibility of the syndrome.


Anand Inder S. Malhotra Ravinder M, Chandershekhar Yallapragada, Bali Harinder K, Chauhan Shamsher S, Bhandari Raj K. Wahi Purshotam L. Subacute Adult Mountain Sickness.   Circulation, 1989: 80-II-88.