Chronic Mountain Sickness-Phobrang Type

Abstract

Clinical0 features of 27 cases of Chronic Mountain Sickness (CMS) from the Himalayas are reported. They are compared with 75 native highlanders (NH). All CMS patients were immigrants to high altitude. Mean duration of stay at high altitude was seven years. Mean values for haematocrit and haemoglobin were 80% and 23 G% respectively for the CMS group and 40% and 17.9 G% respectively for the native highlande group. Mean QRS axis in the former was +118 and in the latter +76. Incidence and quantum of protienuria were significantly higher in the CMS group. Cardiac catheteri -sation studies done in eight CMS cases showed elevated Pulmonary Artery (PA) pressures even after a mean of 14.2 days at sea level. The disease which has four diagnostic elements-hypoxemia and polycythemia, pulmonary hypertension, right ventricular enlargement and nephropathy with dense proteinuria-is a variant of 'Monge's Disease' and a name CMS Phobrang Type is suggested, along with a new approach to clinical classification which may help in diagnosis before cor pulmonale sets in. Limited therapeutic trials conducted at highaltitude seem to indicate that yogic deep breathing exercises, low-dose aspirin and diamox may be beneficial in the prevention and therapy of CMS Phobrang Type at high altitude.