The Relationship Between Acute Mountain Sickness, Patent Foramen Ovale, and Systemic Inflammation
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Date
2020
Authors
Shah, Karina
DiMarco, Kaitlyn
Lovering, Andrew
Journal Title
Journal ISSN
Volume Title
Publisher
University of Oregon
Abstract
Acute mountain sickness (AMS) occurs when individuals rapidly ascend to high altitude, but its exact cause is unknown. A patent foramen ovale (PFO) is a hole in the heart present in one-third of the population. PFO+ subjects have greater AMS incidence, but the reasons are unknown. AMS is associated with systemic inflammation as determined by elevated cytokines and data from our lab suggests that PFO+ subjects have greater systemic inflammation. Thus, we hypothesized that the association between AMS and PFO is explained by increased inflammation. To test this, 17 PFO+ subjects (9 women) and 17 PFO- subjects (9 women) were exposed to 10 hours of hypoxia simulating 15600 feet and AMS was assessed using the Lake Louise Questionnaire. Blood samples taken before and at 10 hours of hypoxia were assayed for 13 inflammatory mediators. We found that 83% of PFO+ subjects but only 61% of PFO- subjects got AMS. AMS- subjects had significantly higher levels of IL-12p70 at 10 hours than AMS+ subjects. All other cytokines had significant time effects, and the greatest increases were in AMS- subjects. Compared to PFO- subjects, PFO+ subjects had significantly higher IL-1β, interferon (IFN)-ɑ2, IL-8, IL-10, and MCP-1 levels before and at 10 hours. PFO+ subjects had the greatest increases in IFN-2, MCP-1, and IL-10 and PFO- subjects had the greatest increases in IL-10 and IL-6. These data suggest inflammation levels differ with PFO and AMS, but with separate patterns. Therefore, systemic inflammation in AMS and PFO may be more complex than previously thought.
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Keywords
acute mountain sickness, patent foramen ovale, inflammation, AMS, PFO