Immersion pulmonary oedema: a cardiological perspective.

It is postulated that immersion pulmonary oedema (IPE) occurs because of combinations of factors that each increase the hydrostatic pressure gradient between the pulmonary capillaries and the alveoli. The factors, by definition, include the effects of immersion, particularly raised central blood volume and hence cardiac filling pressures. Breathing against a negative pressure is important but the magnitude of the effect depends on the relation of the diver's lung centroid to the source of the breathing gas and the breathing characteristics of diving equipment. Other factors are cold-induced vasoconstriction, exertion and emotional stress, but variations of the responses of individuals to these stimuli are important. Hypertension is the most frequent cardiovascular disease predisposing to IPE but other medical conditions are implicated in some patients.