Platypnea induced by worsening of VA/Q inhomogeneity in the sitting position in chronic obstructive lung disease

Patent foramen ovale and the platypnea-orthodeoxia syndrome

The platypnea-orthodeoxia syndrome is a rare but important condition caused by a variety of clinical entities. Several mechanisms have been postulated to cause platypnea and orthodeoxia. These mechanisms mainly involve intracardiac shunting, pulmonary vascular shunting, and ventilation-perfusion mismatching. Patent foramen ovale is an important type of intracardiac shunt that can produce platypnea-orthodeoxia in select patients. Concomitant pulmonary hypertension must be ruled out, but symptoms can occur without pulmonary hypertension in cases with altered intrathoracic anatomy and physiology. Diagnosis usually entails transthoracic or trans-esophageal echocardiogram, ideally with postural provocation by the tilt-table test. Treatment with surgical or percutaneous closure may result in symptomatic relief. The decision to intervene is based mainly on the severity of symptoms and potential morbidities associated with the defect.

Platypnea-orthodeoxia: Report of Two Cases and Review of the Literature

We describe two unusual cases of platypnea. The first patient had chronic obstructive pulmonary disease, but platypnea did not respond to chronic obstructive pulmonary disease therapy. He was found to have multiple pulmonary emboli, and symptoms rapidly improved on anticoagulation therapy. The second patient had Parkinson disease and developed severe platypnea, an association that has not been previously described. She had significant postural hypotension and responded to therapy with fludrocortisone.

Orthodeoxia and platypnoea after acute organophosphorus poisoning reversed by CPAP: a newly described cause and review of the literature

The case of a 60-year-old male patient, who survived severe organophosphorus poisoning, and subsequently developed platypnoea and orthodeoxia is described. The patient was mechanically ventilated for a long period of time in the intensive care unit. During the weaning trial, he developed platypnoea and orthodeoxia (PaO2 85 mmHg in recumbency, and 40 mmHg in upright position). Interestingly, the patient's orthodeoxia was alleviated on continuous positive airway pressure (CPAP) treatment. This is a newly described cause of the platypnoea-orthodeoxia syndrome. The possible pathophysiological mechanisms are discussed and a review of the reported abnormal states associated with this condition is presented.

Platypnea related to constrictive pericarditis

Platypnea is the rare symptom of dyspnea in the upright position, which is relieved by assumption of the recumbent position. This symptom has been previously described in association with several conditions, but never with constrictive pericarditis. The authors report the case of a patient with constrictive pericarditis and severe platypnea, which resolved after pericardiectomy.

Platypnea in the intensive care unit. A newly described cause

Platypnea in a patient with COPD developed during the subacute onset of an ileus. Arterial blood gas studies failed to document orthodeoxia. Routine treatment for COPD failed to resolve the patient's positional dyspnea, but the dyspnea rapidly resolved following resolution of the ileus. The authors postulate that impaired abdominal muscle contraction in the upright position secondary to the ileus was responsible for the development of platypnea.