Northern Pulmonary Hypertension: Personal Experience and Brief History

Andrey L. Chernyaev

https://doi.org/10.1002/pul2.70190 

Abstract

My focus here is to tell the personal and historical story about the discovery and characterization of pulmonary hypertension caused by extreme cold, a condition now recognized as Northern Pulmonary Hypertension (NPH). Residents of the Far North often experience increased fatigue, breathing difficulties, and gas exchange challenges—a condition known as “polar dyspnea”. While many attribute this to a lack of oxygen in the air, studies have shown that sufficient oxygen is present. Still, it is more tightly bound in winter, making gas exchange at the alveolar level more difficult. In April 1980, during my first expedition to Magadan, I experienced “polar dyspnea” firsthand while climbing a modest slope despite being in good physical condition. Later that year, during a trip to 3800 m above sea level, I struggled with pronounced shortness of breath when carrying water uphill. However, I could easily perform the same task after a week at altitude. These experiences illustrate the profound effects of cold and altitude on the human body, as well as the remarkable capacity for adaptation, which inspired me to undertake further studies on this topic.

The groundwork for understanding the effects of cold climates on the cardiovascular system in the USSR was laid by N.R. Paleev, who was the first to compare the impacts of Arctic and Antarctic environments [1]. Diseases in Northern populations, particularly among newcomers, were found to have unique clinical and pathological features compared to those living in temperate zones. In 1965, during a meeting of the Geographical Society of the USSR, my mentor, academician A.P. Avtsyn (Figure 1A,B), reported on pioneering research initiated in Murmansk in 1961 by the “Research Institute of Human Morphology”. This study marked the beginning of systematic studies into human pathology in the North. In 1976, Avtsyn introduced the term “Northern Medicine”, which became the foundation for subsequent investigations into the diseases of Northerners and the processes of adaptation and maladaptation to the harsh conditions of the Far North at low altitude—basically at sea level or just low altitudes. Therefore, cold pulmonary hypertension exists without high-altitude hypoxia.

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