The 2018 Lake Louise Acute Mountain Sickness Score

Roach, Robert C.; Hackett, Peter H.; Oelz, O; Bärtsch, Peter; Luks, Andrew M.; MacInnis, Martin J.; Baillie, J Kenneth

doi:10.1089/ham.2017.0164

Cited by 422 publications

(305 citation statements)

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“…The symptoms are usually most pronounced after the first night spent at a new altitude and resolve spontaneously when appropriate measures are taken [1]. The leading symptom is headache, which is required for the diagnosis of AMS by the most frequently used scoring system [2]. However, this has been questioned by those who argue, based on anecdotal reports, that some individuals ( probably ∼5% [3]) with symptoms clearly attributable to high altitude will be missed by having headache as a compulsory symptom.…”

Section: Ams and Hacementioning

confidence: 99%

Acute high-altitude sickness

2017

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At any point 1-5 days following ascent to altitudes ⩾2500 m, individuals are at risk of developing one of three forms of acute altitude illness: acute mountain sickness, a syndrome of nonspecific symptoms including headache, lassitude, dizziness and nausea; high-altitude cerebral oedema, a potentially fatal illness characterised by ataxia, decreased consciousness and characteristic changes on magnetic resonance imaging; and high-altitude pulmonary oedema, a noncardiogenic form of pulmonary oedema resulting from excessive hypoxic pulmonary vasoconstriction which can be fatal if not recognised and treated promptly. This review provides detailed information about each of these important clinical entities. After reviewing the clinical features, epidemiology and current understanding of the pathophysiology of each disorder, we describe the current pharmacological and nonpharmacological approaches to the prevention and treatment of these diseases.

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Section: Ams and Hacementioning

confidence: 99%

Acute high-altitude sickness

2017

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“…At high altitude, patients were questioned for the occurrence of acute mountain sickness symptoms, using the Lake Louise Score. 15 …”

Section: Other Measurementsmentioning

confidence: 99%

Upward-Shift and Steepening of the Blood Pressure Response to Exercise in Hypertensive Subjects at High Altitude

Baratto

Caravita

Faini

et al. 2018

Journal of Hypertension

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Background--Acute exposure to high-altitude hypobaric hypoxia induces a blood pressure rise in hypertensive humans, both at rest and during exercise. It is unclear whether this phenomenon reflects specific blood pressure hyperreactivity or rather an upward shift of blood pressure levels. We aimed at evaluating the extent and rate of blood pressure rise during exercise in hypertensive subjects acutely exposed to high altitude, and how these alterations can be counterbalanced by antihypertensive treatment.Methods and Results--Fifty-five subjects with mild hypertension, double-blindly randomized to placebo or to a fixed-dose combination of an angiotensin-receptor blocker (telmisartan 80 mg) and a calcium-channel blocker (nifedipine slow release 30 mg), performed a cardiopulmonary exercise test at sea level and after the first night's stay at 3260 m altitude. High-altitude exposure caused both an 8 mm Hg upward shift (P<0.01) and a 0.4 mm Hg/mL/kg per minute steepening (P<0.05) of the systolic blood pressure/oxygen consumption relationship during exercise, independent of treatment. Telmisartan/nifedipine did not modify blood pressure reactivity to exercise (blood pressure/oxygen consumption slope), but downward shifted (P<0.001) the relationship between systolic blood pressure and oxygen consumption by 26 mm Hg, both at sea level and at altitude. Muscle oxygen delivery was not influenced by altitude exposure but was higher on telmisartan/nifedipine than on placebo (P<0.01).Conclusions--In hypertensive subjects exposed to high altitude, we observed a hypoxia-driven upward shift and steepening of the blood pressure response to exercise. The effect of the combination of telmisartan/nifedipine slow release outweighed these changes and was associated with better muscle oxygen delivery. In previous articles, we demonstrated that acute exposure to high-altitude hypobaric hypoxia induces a blood pressure (BP) rise in subjects with hypertension, both at rest over the 24 hours and during exercise, 1-3 likely through chemoreflex-induced sympathetic activation.4-6 Moreover, we also showed that the combination treatment with telmisartan and sustained-release formulation of nifedipine gastrointestinal therapeutic system formulation (GITS) is able to lower BP levels during exercise not only at sea level but also at high altitude, as compared with placebo. However, we previously Indeed, it is a common experience that a given task (eg, climbing stairs, which may correspond to a given workload) may engender extremely different responses in terms of dyspnea, fatigue, or palpitations when conducted either at sea level or at high altitude. For these reasons, in a previous report of ours, we also tried to normalize BP for oxygen consumption (VO 2 ), the latter being acknowledged as a more precise indicator of cardiac output and metabolic needs imposed by exercise than is the measure of workload. However, we assessed this ratio only at peak exercise and not dynamically throughout the different exercise steps. Thus, it remains debated whe...

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“…LLQ score greater than or equal to three and presence of headache is considered positive for AMS [16]. Demographic data included age, sex, whether or not the subject used a paid guide, whether the subject was currently working as a professional guide, prior history of altitude illness, use of acetazolamide or ibuprofen, the participants's altitude of residence, the number of days they took to reach 14 Camp, and the number of hours they had been at 14 Camp at the time of testing.…”

Section: Study Site and Logisticsmentioning

confidence: 99%