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Normal Exercise Capacity in Chronic Mountain SicknessPolycythemia and Exercise at High Altitude: How High Can the Hematocrit Go Without Consequence?

Erik R. Swenson, MD
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine, Medical Service, VA Puget Sound Health Care System, University of Washington.

Correspondence to: Erik R. Swenson, MD, S-111-PULM, Pulmonary and Critical Care Medicine, Medical Service, VA Puget Sound Health Care System, University of Washington, 1660 S Columbian Way, Seattle, WA 98108; e-mail: eswenson@u.washington.edu


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(4):823-825. doi:10.1378/chest.12-0933
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Extract

The defining feature of chronic mountain sickness (CMS) (or Monge disease) is excessive erythrocytosis for the resident altitude, with hematocrit levels reported as high as 90% at 4,350 m.1 CMS is not only a public health problem in the Andes, but also in the Himalaya and Rocky Mountains. Many signs and symptoms stem from increased blood viscosity, greater hypoxemia, and pulmonary hypertension, which reduce cardiac output and effective tissue perfusion and oxygenation, ultimately leading to cor pulmonale and greater mortality.2 Fatigue with polycythemia is a typical finding and is a cardinal symptom in the international consensus definition of CMS.2 Although fatigue is a nonspecific symptom, it is often associated and equated with reduced exercise tolerance, and both are reported in CMS.1,2 Thus, the study by Groepenhoff et al3 in this issue of CHEST (see page 877) of maximal exercise in such patients, which found no evidence of decreased exercise capacity, is most intriguing. The surprising and novel findings of this first-rank cardiopulmonary physiologic investigation forces reconsideration of conventional wisdom.

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