Reversible Orthodeoxia and Platypnea Due to Right-to-Left Intracardiac Shunting Related to Pericardial Effusion
Authors: Eric A. Adolph, William O. Lacy, Yitzchak I. Hermoni, Laura F. Wexler, Shahrokh Javaheri
Journal: Annals of Internal Medicine (1992)

Brief Report15 January 1992Reversible Orthodeoxia and Platypnea Due to Right-to-Left Intracardiac Shunting Related to Pericardial EffusionEric A. Adolph, MD, William O. Lacy, MD, Yitzchak I. Hermoni, MD, Laura F. Wexler, MD, Shahrokh Javaheri, MDEric A. Adolph, MD, William O. Lacy, MD, Yitzchak I. Hermoni, MD, Laura F. Wexler, MD, Shahrokh Javaheri, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-116-2-138 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe rare phenomena of platypnea (dyspnea exacerbated by upright posture and relieved by recumbency) and orthodeoxia (hypoxemia exacerbated by upright posture and relieved by recumbency) have been noted to accompany pulmonary arteriovenous fistulae (1) and severe chronic obstructive lung disease (2, 3) and to occur in patients after thoracotomy (4-7).When arteriovenous fistulae are present in the lower lobes of the lungs, the right-to-left shunt can be accentuated by gravitational forces while the patient is in the upright posture, resulting in hypoxemia (1). In patients with chronic obstructive lung disease, platypnea is caused by a decrease in pulmonary blood flow...References1. RobinLamanHornTheodore EDBJ. Platypnea related to orthodeoxia caused by true vascular lung shunts. N Engl J Med. 1976:294:941-3. CrossrefMedlineGoogle Scholar2. SewardHayesSmithWilliamsRosenowReeder JDHDEG. Platypnea-orthodeoxia: clinical profile, diagnostic workup, management, and report of seven cases. Mayo Clin Proc. 1984:59:221-31. CrossrefMedlineGoogle Scholar3. AltmanRobin ME. Platypnea (diffuse zone I phenomenon?). N Engl J Med. 1969:281:1347-8. CrossrefMedlineGoogle Scholar4. StreitzMaggs JP. Fatal hypoxemia following mitral valve replacement. Ann Thorac Surg. 1988:46:104-5. CrossrefMedlineGoogle Scholar5. Begin R. Platypnea after pneumonectomy. N Engl J Med. 1975:293: 342-3. CrossrefMedlineGoogle Scholar6. LaBreshPietroCoatesKhuriFollandParisi KDESEA. Platypnea syndrome after left pneumonectomy. Chest. 1981:79: 605-7. CrossrefMedlineGoogle Scholar7. FrancoKinasewitzMarkhamTuckerGeorge DGRWR. Postural hypoxemia in the postpneumonectomy patient. Am Rev Resp Dis. 1984:129:1021-2. MedlineGoogle Scholar8. Shapiro B. Clinical Application of Blood Gases. Chicago: Year Book Medical Publishers: 1973:41-5. Google Scholar9. StrunkCheitlinStulbargSchiller BMMN. Right-to-left interatrial shunting through a patent foramen ovale despite normal intracardiac pressures. Am J Cardiol. 1987;60:413-5. CrossrefMedlineGoogle Scholar10. WintersCortesMcDonoughTysonBaierGimenez WFMRHJ. Venoarterial shunting from inferior vena cava to left atrium in atrial septal defects with normal right heart pressures. Report of two cases. Am J Cardiol. 1967:19:293-300. CrossrefMedlineGoogle Scholar11. KlepperSeifertLawsonMallisDervanSmaldone JFWGJG. Intracardiac right-to-left shunting following cardiac surgery. Am Heart J. 1988:116:189-92. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Eric A. Adolph, MD; William O. Lacy, MD; Yitzchak I. Hermoni, MD; Laura F. Wexler, MD; Shahrokh Javaheri, MDAffiliations: From the Department of Veterans Affairs Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio. For current author addresses, see end of text. 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Cheng, MD 15 January 1992Volume 116, Issue 2Page: 138-139KeywordsBlood flowChronic obstructive pulmonary diseaseDyspneaHypoxiaLungsPostural controlPulmonary diseasesThoracotomy ePublished: 1 December 2008 Issue Published: 15 January 1992 PDF downloadLoading ...