Cardiac platypnea–orthodeoxia syndrome induced by a low-volume state. Issue 3 (4th May 2017)

• Record Type: Journal Article
• Authors: Ghijselinck, Pieter; Van den Saffele, Jan; Hollanders, Geert
• Is Part Of: Acta clinica belgica. Volume 72:Issue 3(2017)
• Page Start: 205
• Page End: 209
• Publication Date: 2017-05-04
• Subjects: Atrial septal aneurysm -- Platypnea -- Intracardiac shunts -- Patent foramen ovale -- Aortic root dilatation; Clinical medicine -- Periodicals; Diagnosis, Laboratory -- Periodicals; 616.005
• DOI: 10.1080/17843286.2016.1196863
• Languages: English
• ISSNs: 1784-3286

Abstract

Abstract : We present the case of a 85-year-old patient admitted with palpitations and dyspnea. When assuming a recumbent position, we noticed a significant improvement in dyspnea, as well as a rise in arterial oxygen saturation. This is a typical presentation of platypnea-orthodeoxia syndrome (POS). The diagnosis was confirmed by serial analyses of the arterial oxygen saturation in different positions. In our patient, POS was caused by a cardiac right–left shunt through a patent foramen ovale, facilitated by an atrial septal aneurysm, a dilated aortic root and a large Eustachian valve. A low-volume state, caused by diarrhea and worsened by administration of diuretics in the emergency room, triggered the POS to become clinically apparent. We also noticed a rise in arterial oxygen saturation when the patient was in a hypertensive state. This has never been described before and underlines the influence of hemodynamic changes on the right–left shunt that underlies POS.