What might HAPE feel like? – A Real-Life Case Study

Background: Steve, a 61-year-old male, ex-smoker (quit 25 years prior). Physically fit, including regular hiking in local mountains and endurance events. Progressive climbing experience, with multiple 4000 m summits then several 6000m summits.

HAPE symptoms: After summiting Aconcagua 6962m with his team, Steve began to slow down. He arrived with his guide down to Camp 3 (6100m) about an hour behind the team. “I felt exhaustion during the last hour of the ascent. I put it down to altitude, but I fell slightly behind the team which is very out of character for me. During the night I woke to find myself on my hands and knees, shallow panting and unable to breathe.” The person he was sharing the tent with awakened their guide, who immediately gave Steve supplementary oxygen. A nurse on the team administered appropriate drugs to buy him time to descend. The guide radioed the rescue doctor stationed at a hut below at 5500m, who advised immediate descent to the hut to await helicopter evacuation at first light.

Descent to rescue hut 5500m: “I was beyond exhausted and incapable of sitting up unsupported, so I wasn’t relishing the extra march. But my tent mate and the nurse dressed me, and I had my emptied backpack on my back containing an oxygen cylinder and the oxygen mask on my face.” A guide helped him descend which took 2 – 3 hours. “I was struggling to stay conscious and was hallucinating for the last few hundred metres that I had a little black dog (my daughter’s) constantly running around my feet! Now as I think back, my head was down as I walked, and it was the dancing shadow from my headtorch which produced the image. I can remember being worried about standing on this (non-existent) dog with my crampons!. The rescue hut doctor measured Steve’s oxygen saturation which had fallen to 43% by the time he arrived. He administered further injections and continued oxygen. “I didn’t really sleep. I was feeling very ill by first light when the helicopter came.”

Recovery: “The helicopter flight down was surreal. The pilot kept looking at me and giving me thumbs up”. They were met by an ambulance at the Aconcagua Park gate. Following a hospital x-ray to check for pneumonia, Steve was cleared to fly home. “I recovered 80% very quickly once down at the altitude of the park gate. It took about a week to recover to 90%, and a month to get back to 100%.”. A CT scan showed temporary lung damage from the HAPE, most of which had healed by a second scan six months later.

Note: This is primarily a case of HAPE, but it is accepted that HAPE and HACE often coexist. The neurological symptoms described above such as hallucination are typical of HACE, but also possible in late stage HAPE due to hypoxia (brain not getting enough oxygen to function).