Two skiing enthusiasts, both physicians, recently experienced critical episodes of pulmonary edema while skiing at high altitudes. The skiing area was close to cardiopulmonary laboratory facilities so that complete physiologic measurements were made throughout the course of the illness.1 These data provided understanding of the basic mechanisms of such catastrophic episodes. In the past, patients with this syndrome died on the mountain or they became ill in areas where investigations were necessarily incomplete.
Progressive dyspnea, cough, and cyanosis developed in the first patient, a 48-year-old experienced skier, after he had skied vigorously for 2 days, at altitudes between 8,500 and 10,300 ft. At the time of admission he was moribund. A presystolic gallop was present and the second heart sound over the pulmonic area was split. There was dramatic response to oxygen given by nasal catheter; within 15 minutes the cyanosis and gallop rhythm disappeared. After 4 days of therapy,