High Altitude Medicine and Physiology
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More than half a century has passed since man first stood on the summit of Mount Everest, and the story of man's attempts to climb higher and higher unaided is one of the more colorful and exciting in medicine and physiology. The past few decades have seen an explosion in interest in mountain pursuits in general, as increasing numbers of people take to the mountains for day trips and on longer excursions. As a result, doctors face ever-expanding challenges in dealing with the changes in human physiology and particular medical conditions that arise from exposure to altitude. Building on the success and reputation of previous editions, the fourth edition of High Altitude Medicine and Physiology includes major changes in the scientific content, with updates in many areas. The area of genetics has assumed great importance, along with other advances in molecular biology and medicine, and these are incorporated throughout the text. There are also new or improved sections on women and children at high altitude, the role of vascular endothelial growth factor, neurological disorders at high altitude, athletic training using high altitude, high altitude pulmonary edema, and the problems of patients with pre-existing diseases. Other new features include summary boxes highlighting important concepts, and increased tabulation of key data for rapid reference. While the authors have added much new material, they have also prudently trimmed down the existing material so that the text is still easily manageable and accessible in this fourth edition. High Altitude Medicine and Physiology remains invaluable reading for any doctor accompanying an expedition to—or advising patients on a visit to—a high altitude area, and for those physicians and physiologists who study our dependence on oxygen.
Preface viiAcknowledgments ixConversion tables xList of abbreviations xiHistory 1The atmosphere 15Geography and the human response to altitude 27Altitude acclimatization and deterioration 39Ventilatory response to hypoxia and carbon dioxide 51Pulmonary gas exchange 67Cardiovascular system 85Hematology 103Blood-gas transport and acid-base balance 117Peripheral tissues 131Exercise 145Limiting factors at extreme altitude 161Sleep 177Nutrition, metabolism and intestinal function 189Endocrine and renal systems at altitude 203Central nervous system 221High altitude populations 235Acute mountain sickness 251High altitude cerebral edema 271High altitude pulmonary edema 279Chronic mountain sickness and high altitude pulmonary hypertension 299Other altitude-related conditions: neurovascular disorders, eye conditions, altitude cough, anesthesia at altitude 311The physiology and pathology of heat and cold 325Pre-existing medical conditions at altitude 337Women at altitude 349Extremes of age at altitude: Children and the elderly 353Commuting to high altitude for commercial and other activities 359Athletes and altitude 371Clinical lessons from high altitude 379Practicalities of field studies 389References 399Index 471
