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Platypnea-orthodeoxia syndrome mimicking postural orthostatic tachycardia syndrome. Clin Auton Res 2021; 31:573-576. [PMID: 33886001 PMCID: PMC8060785 DOI: 10.1007/s10286-021-00805-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022]
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Dvoretskiy LI, Rezvan VV. [Platypnea: оne more type position shortness of breath]. TERAPEVT ARKH 2020; 92:92-97. [PMID: 32598799 DOI: 10.26442/00403660.2020.03.000436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Indexed: 11/22/2022]
Abstract
The article presents modern data on the causes of platypnea, methods of its diagnosis and treatment. The data on the development of platypnea syndrome are given not only in cardiac pathology, but also in severe liver diseases with the development of hepatopulmonary syndrome and chronic obstructive pulmonary disease of a severe course.
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Affiliation(s)
- L I Dvoretskiy
- Sechenov First Moscow State Medical University (Sechenov University)
| | - V V Rezvan
- Sechenov First Moscow State Medical University (Sechenov University)
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Liew F, Gargoum F, Potter R, Rosen SD, Ward S, Hind M, Polkey MI. Platypnoea-orthodeoxia syndrome: beware of investigations undertaken supine. Thorax 2019; 74:917-919. [PMID: 31147400 DOI: 10.1136/thoraxjnl-2019-213258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/05/2019] [Accepted: 04/30/2019] [Indexed: 11/04/2022]
Abstract
Platypnoea-orthodeoxia syndrome (POS) is a rare disorder, manifesting as deoxygenation occurring when the patient is in the upright position. Four broad mechanisms for the condition have been described: intracardiac shunts, intrapulmonary shunts, hepatopulmonary syndrome and pulmonary ventilation-perfusion mismatch. Here, we present the first case of POS in a patient with a proven right to left intracardiac shunt occurring in the context of postural hypotension and normal right heart pressures. We highlight the need to carry out investigations in the upright position before discounting intracardiac shunting as a cause for the syndrome. Short-term improvement of the syndrome was obtained with medical management of the patient's orthostatic hypotension and as such suggests a conservative management strategy for similar patients, which may delay the need for invasive procedures to close the anatomical defect.
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Affiliation(s)
- Felicity Liew
- Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Fatma Gargoum
- Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Robert Potter
- Department of Cardiology, Ealing Hospital, Southall, Middlesex, UK
| | - Stuart D Rosen
- Department of Cardiology, National Heart and Lung Institute, London, London, UK.,Department of Cardiology, Ealing Hospital NHS Trust, Harrow, London, UK
| | - Simon Ward
- Lung Function Unit, Royal Brompton Hospital, London, London, UK
| | - Matthew Hind
- Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Michael I Polkey
- Respiratory Medicine, Royal Brompton Hospital, London, UK.,Respiratory Medicine, The National Heart and Lung Institute, Imperial College London, London, UK
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Porter BS, Hettleman B. Treatment of Platypnea-Orthodeoxia Syndrome in a Patient with Normal Cardiac Hemodynamics: A Review of Mechanisms with Implications for Management. Methodist Debakey Cardiovasc J 2018; 14:141-146. [PMID: 29977471 DOI: 10.14797/mdcj-14-2-141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Platypnea-orthodeoxia syndrome is a rare entity characterized by dyspnea and hypoxemia in the sitting position and usually resolved by lying down. Although it is not well understood, it is thought to be associated with either intracardiac or extracardiac factors. Within the group of intracardiac etiologies, it typically occurs in the presence of right heart failure or elevated right-sided filling pressures. When right heart failure is absent, platypnea-orthodeoxia is thought to be due to either anatomic changes that produce a baffle-directing flow across an atrial defect or to posture-dependent right-to-left pressure gradients. We report this case of a patient with no prior diagnosis of heart failure who presented to our hospital with 6 months of New York Heart Association class IV dyspnea and recent paradoxical embolus across a patent foramen ovale (PFO). Platypnea-orthodeoxia syndrome was diagnosed clinically. Transesophageal echocardiography revealed bidirectional shunting across the PFO. In the catheterization laboratory, invasive hemodynamics showed normal right and left atrial pressures and normal pulmonary arterial pressures. An Amplatzer Cribiform occluder device (AGA Medical Corp.) was used to close the PFO, completely curing the patient's symptoms. This is a novel case of subacute-onset severe platypnea-orthodeoxia associated with paradoxical embolus occurring while seated in the upright position. The cause of the patient's symptoms may have been progressive kyphosis or to increased pulmonary tidal volumes. Evaluation for platypnea-orthodeoxia is important in cases of occult dyspnea because the condition may be cured by closing the anatomic defect, as it was in this case.
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Zardi EM, Spoto S, Locorriere L, Cacioli G, Mazzaroppi S, Zobel BB, Di Sciascio G, Costantino S. Platypnoea-orthodeoxia syndrome in the elderly: A difficult-to-make diagnosis of intracardiac right-to-left shunt. Scott Med J 2017; 62:122-125. [DOI: 10.1177/0036933017727430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Platypnea-orthodeoxia syndrome is a combination of positional dyspnoea and hypoxemia; it is caused by several cardiac, pulmonary and hepatic diseases. Case presentation In this study, we describe a 77-year-old female affected by unexplained dizziness and hypoxia that exacerbated in upright position. After diagnosing platypnea-orthodeoxia syndrome and excluding all possible causes (liver cirrhosis, acute and chronic pulmonary diseases and arteriovenous malformations), the origin of the syndrome was individuated in the presence of a patent foramen ovale with right-to-left shunt. Endovascular patent foramen ovale closure permitted the resolution of symptoms and disappearance of platypnea-orthodeoxia syndrome. Conclusion Although patent foramen ovale may be present since birth without giving clinical signs, it may represent a common enough cause of platypnea-orthodeoxia syndrome and other vascular complications in the elderly.
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Affiliation(s)
- Enrico M Zardi
- MD, PhD, Internal Medicine, Campus Bio-Medico University, Rome, Italy
| | - Silvia Spoto
- MD, Internal Medicine, Campus Bio-Medico University, Rome, Italy
| | | | - Giulio Cacioli
- MD, Internal Medicine, Campus Bio-Medico University, Rome, Italy
| | | | - Bruno B Zobel
- Full Professor, Internal Medicine, Campus Bio-Medico University, Rome, Italy
| | - Germano Di Sciascio
- Full Professor, Internal Medicine, Campus Bio-Medico University, Rome, Italy
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The multiple dimensions of Platypnea-Orthodeoxia syndrome: A review. Respir Med 2017; 129:31-38. [PMID: 28732833 DOI: 10.1016/j.rmed.2017.05.016] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 05/27/2017] [Accepted: 05/29/2017] [Indexed: 12/18/2022]
Abstract
Platypnea-Orthodeoxia syndrome (POS) is a rare clinical entity characterized by dyspnea and arterial desaturation while in the upright position. The various pathophysiologic mechanisms leading to POS has puzzled clinicians for years. The hypoxia in POS has been attributed to the mixing of the deoxygenated venous blood with the oxygenated arterial blood via a shunt. The primary mechanisms of POS in these patients can be broadly classified based on intracardiac abnormalities, extracardiac abnormalities and miscellaneous etiologies. A Patent Foramen Ovale (PFO) was the most common reported site of an intracardiac shunt. In addition to PFO, intracardiac shunt leading to POS has been reported from either an Atrial Septal Defect (ASD) or an Atrial Septal Aneurysm (ASA). Most patients with an intracardiac shunt also demonstrated a secondary anatomic or a functional defect. Extracardiac causes of POS included intra-pulmonary arteriovenous malformations and lung parenchymal diseases. A systematic evaluation is necessary to identify the underlying cause and institute an appropriate intervention. We conducted a review of literature and reviewed 239 cases of POS. In this article, we review the etiology and pathophysiology of POS and also summarize the diagnostic algorithms and treatment modalities available for early diagnosis and prompt treatment of patients presenting with symptoms of platypnea and/or orthodeoxia.
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Mercier V, Tragas G, Compère P, Lefebvre P, Van Meerhaeghe A. [Platypnea, orthodeoxia… A report of two cases]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:96-99. [PMID: 28262410 DOI: 10.1016/j.pneumo.2016.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/15/2016] [Accepted: 12/21/2016] [Indexed: 06/06/2023]
Abstract
The plathypnea orthodeoxia syndrome is a rare condition that is characterized by dyspnea and hypoxia that occurs in the upright position and improves with recumbency. The diagnostic is often made tardively and requires the combination of two components: a mechanical one (for example a patent foramen ovale) and a kinetic one (for example COPD). This combination contributes to the blood flow through the communication. The treatment consists of closing the veno-arterial communication (in the case of a patent foramen ovale, the closing of the inter-atrial septum) (Knapper et al, 2014). In the present article, we describe two severe hypoxemic patients suffering from this syndrome. Both cases were associated with an acute pulmonary disease. A review of the literature is performed.
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Diaconu C, Abdou V, Safar B, Monsel F, Amara W. [Platypnea-orthodeoxia syndrome: A case of hypoxemia associated with a patent foramen ovale]. Ann Cardiol Angeiol (Paris) 2015; 64:406-9. [PMID: 26482634 DOI: 10.1016/j.ancard.2015.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 09/03/2015] [Indexed: 11/24/2022]
Abstract
Platypnea-orthodeoxia syndrome is a rare disease characterized by dyspnea and oxygen desaturation in the upright position with improvement in the supine position. We report a case of an 87-year-old woman with a recent history of traumatic hip, spine deformity and vertebral compression fracture, referred due to dyspnea oxygen desaturation. Thoracic tomodensitometry excluded the diagnosis of pulmonary embolism. Transthoracic echocardiography, with intravenous administration of agitated saline contrast solution, revealed the presence of atrial septal defect associated with a right to left shunting and mild enlargement of aortic root. Surgical closure of atrial septal defect resulted in resolution of the syndrome.
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Affiliation(s)
- C Diaconu
- GHI le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - V Abdou
- GHI le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - B Safar
- GHI le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - F Monsel
- GHI le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - W Amara
- GHI le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France.
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Mojadidi MK, Gevorgyan R, Noureddin N, Tobis JM. The effect of patent foramen ovale closure in patients with platypnea-orthodeoxia syndrome. Catheter Cardiovasc Interv 2015; 86:701-7. [DOI: 10.1002/ccd.25953] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/15/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Mohammad Khalid Mojadidi
- Department of Internal Medicine; Albert Einstein College of Medicine; Jacobi Medical Center; New York
| | - Rubine Gevorgyan
- Program in Interventional Cardiology; Division of Cardiology; David Geffen School of Medicine; University of California at Los Angeles; Los Angeles California
| | - Nabil Noureddin
- Program in Interventional Cardiology; Division of Cardiology; David Geffen School of Medicine; University of California at Los Angeles; Los Angeles California
| | - Jonathan M. Tobis
- Program in Interventional Cardiology; Division of Cardiology; David Geffen School of Medicine; University of California at Los Angeles; Los Angeles California
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Cheaito R, Benamer H, Tritar A, Hage F, Haziza F, Piechaud JF, El-Amine S, Medkour F, Morice MC, Jessen P. [Platypnea-orthodeoxia revealed by recurrent syncope episodes]. Ann Cardiol Angeiol (Paris) 2014; 63:451-4. [PMID: 25450994 DOI: 10.1016/j.ancard.2014.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Platypnea-orthodeoxia is a rare clinical condition which must be examined as a differential diagnosis for any bout of faintness occurring during standing or dyspnea that is exacerbated by standing. This syndrome is often associated with a patent foramen ovale. Its physiopathology is not univocal and the association of many anatomical criteria seems to be mandatory. Contrast echocardiography confirms diagnosis and closure of the patent foramen ovale during interventional catheterization and is currently the therapeutic method of choice. After closure of the foramen ovale, clinical improvement is spectacular and durable.
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Affiliation(s)
- R Cheaito
- Hôpital privé Jacques-Cartier, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Foch, 40, rue Worth, 92151 Suresnes, France.
| | - H Benamer
- Hôpital européen de Paris, La Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital privé Jacques-Cartier, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - A Tritar
- Hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - F Hage
- Hôpital privé Jacques-Cartier, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - F Haziza
- Hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - J-F Piechaud
- Hôpital privé Jacques-Cartier, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - S El-Amine
- Hôpital européen de Paris, La Roseraie, 120, avenue de la République, 93300 Aubervilliers, France
| | - F Medkour
- Hôpital européen de Paris, La Roseraie, 120, avenue de la République, 93300 Aubervilliers, France
| | - M-C Morice
- Hôpital privé Jacques-Cartier, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - P Jessen
- Hôpital européen de Paris, La Roseraie, 120, avenue de la République, 93300 Aubervilliers, France
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Deroux A, Chidlovskii E, Bosc C, Pison C, Couturier P. [Platypnea-orthodeoxia syndrome: a rare cause of severe hypoxemia]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:307-310. [PMID: 24661885 DOI: 10.1016/j.pneumo.2014.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 01/08/2014] [Accepted: 01/18/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The platypnea-orthodeoxia syndrome (PO) includes: (i) a dyspnea increasing with orthostatism and decreasing in supine position, (ii) wide positional range in arterial oxygen saturation with tachycardia, (iii) and hypoxemia refractory to oxygen therapy. This syndrome is usually related to a cardiac right-left shunt, and rarely to a pulmonary shunt. OBSERVATION We report a case of a patient presenting with a post-lung infection dyspnea associated with severe hypoxemia and shunt effect at blood gas. Contrast-enhanced CT-scan showed no pulmonary embolism. PO syndrome was suspected given the transcutaneous blood oxygen saturation variation from 90% in supine position to 60% in standing position, tachycardia, and absence of response to the intensive oxygen therapy. CONCLUSION This syndrome should be known by physicians as a possible differential diagnose for refractory dyspnea to oxygen since effective treatment is available.
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Affiliation(s)
- A Deroux
- Service de médecine aiguë gériatrique, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France.
| | - E Chidlovskii
- Service de médecine aiguë gériatrique, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
| | - C Bosc
- Service de pneumologie, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
| | - C Pison
- Service de pneumologie, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
| | - P Couturier
- Clinique universitaire de médecine gériatrique, pôle pluridisciplinaire de médecine, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
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Takhar R, Biswas R, Arora A, Jain V. Platypnoea-orthodeoxia syndrome: novel cause for a known condition. BMJ Case Rep 2014; 2014:bcr-2013-201284. [PMID: 24717854 DOI: 10.1136/bcr-2013-201284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
A 50-year-old man presented with dyspnoea while sitting, standing and walking but resolved completely in supine position. On cardiorespiratory examinations, fine crackles were noted over bibasal area. Chest X-ray showed bilateral reticulonodular shadows, restrictive pattern on spirometry, elevated alveolar arterial O2 gradient on arterial blood gas. High-resolution CT of the thorax revealed pattern as 'confident' or 'certain' radiographic diagnosis of idiopathic pulmonary fibrosis (IPF). Bubble-contrast echocardiography in recumbent, sitting and upright positions revealed no intracardiac (right to left shunt) or intrapulmonary shunts. This case highlights the necessity of awareness of this syndrome in cases of interstitial lung diseases (ILDs) also. Although 188 cases have been described thus far of platypnoea-orthodeoxia syndrome (P-OS) of various aetiologies, to the best of our knowledge, it is the first ever case of P-OS in ILD/IPF. Both lung bases were predominantly affected in this patient, platypnoea and orthodeoxia were attributed to areas of low/zero ventilation/perfusion (V/Q) ratio (zone 1 phenomena) as no other obvious explanation was found.
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Affiliation(s)
- Rajendra Takhar
- Department of Pulmonary Medicine, Peoples College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India
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Ali OM, Agarwal A, Akram S. Platypnea orthodeoxia: a 'laid-back' case of dyspnoea. BMJ Case Rep 2013; 2013:bcr-2012-007810. [PMID: 23362060 DOI: 10.1136/bcr-2012-007810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A man with end-stage liver disease who presented with shortness of breath. He exhibited clinical platypnea (worsening shortness of breath on sitting up) and orthodeoxia (oxygen desaturation on sitting up). Follow-up investigations led to the diagnosis of hepatopulmonary syndrome.
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Affiliation(s)
- Omair M Ali
- Department of Internal Medicine, Wright State University, Dayton, Ohio, USA.
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Seetharaman S, Lams B, Rudd A, Birns J. Pulmonary and paradoxical embolism with platypnoea-orthodeoxia. Br J Hosp Med (Lond) 2011; 72:652-3. [PMID: 22083010 DOI: 10.12968/hmed.2011.72.11.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article outlines the case of a 62-year-old man who presented with a deep vein thrombosis, pulmonary embolus and right middle cerebral artery territory ischaemic stroke in association with a patent foramen ovale with right-to-left shunting. Despite anticoagulation, he was noted to have desaturation and tachypnoea when upright, without other symptoms or cardiovascular compromise, that resolved on lying down. The article describes the syndrome of platypnoea-orthodeoxia, characterized by breathlessness, hypoxia and/or cyanosis while in the upright position that improves on lying down, its relationship to this case, and its resolution by closure of the patent foramen ovale.
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High risk closure of a large secundum ASD causing platypnea-orthodeoxia. Int J Cardiol 2011; 152:e52-4. [PMID: 21194772 DOI: 10.1016/j.ijcard.2010.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 12/04/2010] [Indexed: 11/24/2022]
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Abstract
A 78-year-old man with a history of gastric ulcer and pulmonary embolism was admitted for elective revision of a right total hip replacement. He was mildly hypoxic preoperatively (saturation 89% on air). He became profoundly breathless postoperatively (saturation 75%). He was treated for presumed pulmonary oedema but failed to improve. A CT pulmonary angiogram and transthoracic echo showed no clear cause for his symptoms. Because the patient's symptoms were postural, exacerbated in the upright position and relieved by lying supine, the authors suspected a diagnosis of platypnoea-orthodeoxia syndrome associated with a patent foramen ovale (PFO). Transoesophageal echo and microbubble study confirmed he had a PFO. The patient's PFO was percutaneously closed and his symptoms and positional hypoxia completely resolved.
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Affiliation(s)
- J Vasant
- Department of Medical Education, Royal United Hospital, Bath, UK.
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Platypnea-Orthodeoxia: Bilateral Lower-Lobe Pulmonary Emboli and Review of Associated Pathophysiology and Management. South Med J 2011; 104:215-21. [DOI: 10.1097/smj.0b013e31820bfb54] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Katsoulis K, Minasidis I, Vainas A, Bikas C, Kontakiotis T, Vakianis P. Platypnea and orthodeoxia associated with Pneumocystis jiroveci and Cytomegalovirus pneumonia: a case report. J Med Case Rep 2009; 3:9319. [PMID: 20062748 PMCID: PMC2803842 DOI: 10.1186/1752-1947-3-9319] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 12/05/2009] [Indexed: 12/04/2022] Open
Abstract
Introduction Platypnea-orthodeoxia is an uncommon syndrome characterized by dyspnea and deoxygenation accompanying a change to a sitting or standing posture from a recumbent position. It is usually related to interatrial communications, although several other disorders associated with platypnea-orthodeoxia syndrome have been reported. However, the precise mechanisms are unknown. Case presentation We present the case of a 75-year-old Caucasian woman with chronic renal failure due to vasculitis who was admitted with fever and respiratory failure. She was found to have both Pneumocystis jiroveci and Cytomegalovirus pneumonia. She was HIV negative. Severe platypnea and orthodeoxia were major features of her illness with no history of respiratory, liver or cardiac disease. Further investigation with contrast echocardiography revealed no intracardiac or intrapulmonary shunts. Although one case involving Pneumocystis jiroveci pneumonia and platypnea has been previously reported, to the best of our knowledge, this is the first time that two opportunistic pathogens have been accompanied by platypnea and orthodeoxia. As both lung bases were predominantly affected and no obvious explanation was found, platypnea and orthodeoxia were attributed to significant areas of low or zero ventilation/perfusion (V/Q) ratio. Conclusion Platypnea-orthodeoxia is a rare and usually underestimated syndrome. Intracardiac shunts and anatomic pulmonary vascular shunts are the most common etiologic associations. However, if a detailed examination reveals no obvious intracardiac or intrapulmonary shunting combined with extensive pulmonary lesions, then severe V/Q mismatching should be considered as the probable explanation.
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Hashimoto M, Okawa Y, Baba H, Nishimura Y, Aoki M. Platypnea–orthodeoxia syndrome combined with constrictive pericarditis after coronary artery bypass surgery. J Thorac Cardiovasc Surg 2006; 132:1225-6. [PMID: 17059949 DOI: 10.1016/j.jtcvs.2006.07.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2006] [Revised: 06/21/2006] [Accepted: 07/12/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Masaki Hashimoto
- Division of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Aichi, Japan.
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Woods TD, Patel A. A critical review of patent foramen ovale detection using saline contrast echocardiography: when bubbles lie. J Am Soc Echocardiogr 2006; 19:215-22. [PMID: 16455428 DOI: 10.1016/j.echo.2005.09.023] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Indexed: 12/20/2022]
Abstract
Saline and indocyanine green dye were the first agents noted to produce a contrast effect when injected peripherally during M-mode echocardiographic imaging, although it was subsequently found that almost any type of injected solution would have this effect. These first-generation contrast agents were limited to opacification of right heart structures, and they prompted subsequent development of agents that traverse pulmonary circulation. Although opacification limited to right heart structures is considered a limitation of these first-generation agents, this is an advantage when attempting to identify the presence of right-to-left shunt. First-generation air contrast is considered the gold standard for identification of patent foramen ovale (PFO). However, PFO investigators have used varying criteria to define abnormal contrast studies. There are also multiple mechanisms by which saline contrast studies may produce both false-positive and false-negative results for presence of PFO. There is mounting experimental evidence that PFO is associated with cerebral ischemia and migraine headache, with a resulting evolution of devices for percutaneous closure of these shunts. Echocardiographic physicians must be aware of potential pitfalls of the air contrast technique to avoid exposing patients to unnecessary risk of closure devices, and missing the potential benefit of shunt closure in appropriately selected patients.
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Affiliation(s)
- Timothy D Woods
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Ortega Trujillo JR, de Lezo Herreros de Tejada JS, García Quintana A, Melián Nuez F, Rodríguez Delgado R, Fernández-Aceytuno AM. Cierre percutáneo de foramen oval permeable en el síndrome platipnea-ortodesoxia. Rev Esp Cardiol 2006. [DOI: 10.1157/13083655] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gibbons CH, Freeman R. Orthostatic dyspnea: a neglected symptom of orthostatic hypotension. Clin Auton Res 2005; 15:40-4. [PMID: 15768201 DOI: 10.1007/s10286-005-0227-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2004] [Accepted: 09/21/2004] [Indexed: 10/25/2022]
Abstract
Dyspnea is a common symptom in patients with pulmonary and cardiac disease. Orthostatic hypotension is rarely considered a cause of dyspnea. We reviewed the medical records of 651 consecutive patients referred for the evaluation of dysautonomia to investigate the prevalence of dyspnea and its association with OH and other autonomic abnormalities. Dyspnea was reported by questionnaire in 30% of patients with OH, compared to 10% of age and sex matched patients without OH (P<0.05, chi(2)). There was a trend toward earlier blood pressure falls in patients with dyspnea. During autonomic testing, 25% of patients (10 of 40) with OH who reported dyspnea on the questionnaire had shortness of breath coincident with blood pressure falls during tilt table and active standing. The time to maximal blood pressure fall was shorter in patients with OH who experienced shortness of breath during testing compared to those without dyspnea (11 minutes vs. 21 minutes, P<0.05). In this study, dyspnea was frequently associated with OH. Ventilation perfusion mismatch, due to inadequate perfusion of ventilated lung apices may be the most likely underlying cause of orthostatic dyspnea in patients with OH.
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Affiliation(s)
- Christopher H Gibbons
- Autonomic and Peripheral Nerve Laboratory, Dept. of Neurology, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA 02215, USA
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