Unexplained dyspnea in an old patient with recurrent stroke: platypnea–orthodeoxia syndrome and evidence of patent foramen ovale
2010
Platypnea–orthodeoxia is a syndrome characterized by dyspnea and
hypoxemiain orthostatism relieved by
supine position. This phenomenon is frequently associated with interatrial communication, mainly
patent foramen ovale. The association of
platypnea–orthodeoxia syndrome with recurrent stroke and
patent foramen ovaleis extremely uncommon. A 73-year-old woman experienced recurrent attacks of dyspnea after an ischemic stroke.
Arterial blood gas analysischanges in upright and
supine positionconfirmed the diagnosis of
platypnea–orthodeoxia syndrome. Contrast-enhanced transthoracic echocardiography showed
patent foramen ovalewith atrial septal aneurysm and
right-to-
left shunt. Percutaneous closure of
patent foramen ovaleled to stabilization of blood oxygen saturation and resolution of dyspnea.
Platypnea–orthodeoxia syndrome should be considered in patients with stroke and unexplained dyspnea. The diagnosis could lead to correction of an unknown cardiac defect and of potential risk factor for stroke.
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