Effect of digoxin and diuretics on high altitude left ventricular dysfunction.

Systolic time intervals, stroke volume, cardiac output and (dZ/dt)/RZ index were serially estimated in 51 normal healthy volunteers at sea level, for ten days after air induction to 3658 m altitude and on return to sea level. The subjects were divided into three groups and were administered a diuretic, beta methyldigoxin and placebo in a double blind protocol. The group on placebo showed an increase in heart rate, reduction in stroke index and cardiac index during high altitude exposure with normalization on return to sea level. A deterioration in left ventricular function as manifested by prolongation of pre-ejection period, increase in PEP/LVET ratio, reduction in (dZ/dt)/RZ index and left ventricular ejection time was also noted at high altitude. The subjects on digoxin maintained normal stroke/cardiac index and did not show any significant changes in the parameters of myocardial function. The diuretic group showed more deterioration in the parameters than the placebo group. No significant side effects were noted. Left ventricular dysfunction and reduction of stroke index at high altitudes may be causually related; digoxin administration may prevent them from occurring.

Urinary catecholamine excretion in temporary residents of high altitude.

Urinary catecholamine excretion was estimated in 50 lowlanders temporarily staying at altitudes above 3,000 m. They were divided in subgroups according to the length of their continuous stay. For comparison, 25 highlanders who were born and brought up at high altitude and 50 lowlanders who had never been to altitudes of more than 1,000 m were also studied. High catecholamine excretion was noted in temporary residents staying at high altitude for up to 30 days as compared to that in lowlanders (P greater than 0.01). The excretion rate gradually returned to basal values thereafter. Catecholamines were essentially similar in lowlanders and highlanders. The significance of these findings is discussed regarding the possible pathogenetic role of the sympathoadrenal system in the development of ill effects in respone to high-altitude exposure.

Neurological and related manifestations of cysticercosis.

Neurological and related manifestations of 17 cases of human cysticercosis have been reported. The cases have been grouped into convulsive disorder (6 cases), meningo-encephalitis (4 cases), pseudo-tumour syndrome (2 cases), psychiatric disease (2 cases), ocular cysticercosis (2 cases) and pseudomuscular hypertrophy (1 case) which proves the varied clinical manifestations of the disease.

Effect of high-altitude exposure for 10 days on stroke volume and cardiac output.

Resting stroke volume and cardiac output of 50 normal healthy sea-level residents (group A) were estimated by the noninvasive technique of electrical impedance plethysmography. They were then airlifted to an altitude of 3,658 m and serial estimations carried out at 0-4 h and 5-8 h and on the 2nd, 3rd, 4th, 5th, and 10th days. The subjects were brought back to sea level and studied for up to 5 days. Thirty permanent residents of high altitude (group B) and sixteen lowlanders temporarily resident at high altitude (group C) were also subjected to similar studies. It was found that resting stroke volume and cardiac output of group A started falling immediately on arrival at high altitude, reached the minimum on the 3rd day and tended to improved on the 4th and 5th day, but showed a secondary fall on the 10th day. The reduction in stroke volume in this group was not fully compensated by tachycardia. On return to sea level the cardiac output normalized immediately, the stroke volume on the 2nd day. At sea level goup A had values similar to group B and at high altitude to group C.

Urinary catecholamine excretion on induction to high altitude (3,658 m) by air and road.

In a preliminary pilot study we had reported a significant difference in urinary catecholamine excretion between symptomatic and asymptomatic individuals inducted to high altitude by air. The present study covers slower induction by road; 25 lowlanders ascended from 1,800 to 3,658 m in 50 h and 33 similar subjects covered the journey in 6 h. They were studied according to the protocal used in the initial study. None of the 58 subjects inducted by road developed symptoms of high-altitude illness. Their urinary catecholamine excretion remained normal during the 10 days' stay at high altitude. These findings lend support to our earlier contention that there might be a relationship between increased sympathoadrenal activity and high-altitude illnesses.

Study of the pituitary-thyroid functions at high altitude in man.

The alterations in serum levels of T3, T4, TSH and TBG, TSH response to 100 mug iv TRH, and urinary excretion of T3 and T4 were studied in 8 healthy men at sea level (SL), on days 1, 2, 4, 8 and 16 after arrival by air at high altitude (3,700 m, HA), and during days 5 to 7 after their return to SL. No significant alterations in serum levels of TSH and TBG or TSH response to TRH were observed during exposure to HA or on return to SL. There was, however, an acute elevation in both serum total T3 and T4. Serum total T3 from a mean basal+/-SE value of 128+/-13 ng/dl increased to 320+/-18 on day 1 and remained significantly elevated at 225+/-48 up to day 8 after arrival at high altitude. Similarly serum total T4 increased from basal level of 9+/-0.92 mug/dl to 15.2+/-1.2 and remained elevated till day 16 and it was 11+/-1.19 mug/dl during days 5 to 7 after return to SL. The urinary excretion of both T3 and T4 was decreased. These changes perhaps were the result of complex physiologic adjustments on acute exposure to high altitude, like shrinkage of the T3 and T4 distribution pools, altered binding capacities of thyroid hormones binding proteins, and a reduction in clearance of thyroid hormones from the plasma compartment; and were probably not suggestive of an enhanced thyroid activity. Their actual significance in high altitude adaptation in man is not clearly understood.

Effect of positive acceleration (+gz) on electrocardiogram of subjects with vasoregulatory abnormality.

ST-T wave changes in the electrocardiogram detected during routine examination and aggravated by erect posture, hyperventilation, and exercise in apparently healthy young individuals have been termed vasoregulatory abnormalities. No evidence of ischaemic heart disease has been found in such subjects. Ten young healthy air crew with vasoregulatory abnormalities were subjected to maximal exercise on treadmill and procedure repeated after 120 mg propranolol daily for 3 days. After one week, they were subjected to a stress of positive acceleration (+gz) in a human centrifuge at 2-5 g and 3-5 g for 15 seconds each at a constant rate of rise of 0-1 g/s and the electrocardiogram was monitored during and in the post-acceleration phase. The procedure was repeated after propranolol 120 mg daily for 3 days. The stress of positive acceleration resulted in pronounced prominence of P waves and inversion of T waves (as has been reported in normal subjects) with minimal ST depression in the electrocardiogram. ST segment depression during exercise, at heart rates corresponding to those achieved during peak centrifuge runs, was significantly more pronounced. The ST, P, and T wave changes were returned to normal after propranolol. It is concluded that minimal ST segment depression after stress of positive acceleration as compared with conspicuous ST segment depression during exercise at corresponding heart rates, and their normalisation after propranolol, rules out ischaemia as an aetiological factor in subjects with vasoregulatory abnormalities.

Changes in transthoracic electrical impedance at high altitude.

Mean transthoracic electrical impedance (impedance) which is inversely related to intrathoracic extravascular fluid volume was measured in 121 normal healthy volunteers at sea-level and at 3658 metres altitude. Fifty (group A) reached the high altitude location after an hour's journey in a pressurised aircraft. Twenty-five (group D) underwent slow road ascent including acclimatisation en route. Thirty permanent residents (group B) and 16 temporary residents at high altitude (group C) were also studied. Serial studies in the 30 subjects of group A who developed symptoms of high altidue sickness showed a significant decrease of impedance up to the fourth day of exposure to high altitude which later returned to normal. The 4 volunteers who developed severe symptoms showed the largest drop in impedance. A case of acute pulmonary oedema developing at 4300 metres showed an impedance value of 24-1 ohms on admission. After effective treatment the impedance increased by 11-9 to 36-0 ohms. Twenty asymptomatic subjects of group A and 25 of group D showed a small average increase in impedance values at high altitude. These obstructions suggest that measurement of transthoracic electrical impedance may be a valuable means of detecting incipient high altitude pulmonary oedema.

Urinary catecholamine excretion on acute induction to high altitide (3,658 m).

Fifty healthy male volunteers, 21-34 yr of age, normally resident at altitudes less than 1,000 m, were airlifted to 3,658 m. Urinary excretion of catecholamines was measured at sea level (198 m) and on the 1st, 2nd, 4th, and 10th day of a stay at high altitude. The symptoms observed on exposure to high altitude were assigned arbitrary scores. The volunteers could, on this basis, be divided into "symptomatic" and "asymptomatic" groups. The two groups showed a markedly different pattern of urinary catecholamines excretion on exposure to high altitude and on return to sea level. Significant increase in the catecholamine excretion was observed in the symptomatic group only. A possible role for enhanced sympathoadrenal activity in the etiopathogenesis of high-altitude illnesses is postulated.

Exercise in an hypoxic environment as a screening test for ischaemic heart disease.

Submaximal and maximal exercise testing have been used to predict coronary events but these tests do not give reliable information regarding employability of subjects with abnormal electrocardiogram. In 30 subjects with stabilized ischaemic heart disease (Group A) and 70 subjects with abnormal resting electrocardiogram (Group B), resting electrocardiograms--at ground level and at a simulated height of 4592 m (15000 ft)--after 40-min exposures were recorded. The double Master's two-step exercise test (DM) was performed at ground level as well as at stimulated height (DMH). In the ischaemic group, exercise combined with hypoxia did not yield better results than exercise alone; but among the asymptomatic subjects, exercise in an hypoxic environment gave significantly better results than exercise alone (p less than 0.005) or hypoxia alone (p less than 0.01). Those with negative responses to the test have been employed on strenous duties, including employment at high altitude for the last 3 years. None of them have manifested any objective or subjective evidence of ischaemic heart disease. DM exercise testing in an hypoxic environment is a reliable method to assess subjects with abnormal electrocardiogram and evaluate their functional status.