Citation Information :
Gallagher G, Joseph A, Rajendram R. Platypnea-Orthodeoxia: Patent Foramen Ovale Unmasked by Pulmonary Emboli. Indian J Respir Care 2018; 7 (1):50-52.
This report describes an 84 year old woman who presented with breathlessness from platypnea-orthodeoxia. This was due to a distortion of a patent foramen ovale by lower thoracic vertebral fractures which allowed a right-to-left intracardiac shunt. The right-to-left shunt was, in this case, triggered by small bilateral pulmonary emboli. Platypnea-orthodeoxia is rare, complex, and underdiagnosed. The pathogenesis requires an anatomical substrate for a shunt and a functional component that triggers reversal of the flow across it. Recognition is critical and may prevent provision of sedation, invasive ventilatory support, and vasopressor; all of which actually exacerbate right-to-left extrapulmonary shunt.
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