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Respiratory Symptoms
Published in James M. Rippe, Lifestyle Medicine, 2019
Jeremy B. Richards, Richard M. Schwartzstein
Platypnea describes the development of tachypnea and hyperventilation when the patient is in the upright position. It is a physical finding rather than a symptom; although, the patient may also complain of associated breathing discomfort. The exact mechanism of platypnea is unclear, but it probably relates to pathology at the lung bases with stimulation of pulmonary receptors or worsening gas exchange when blood flow increases to these areas with the patient upright.
Perioperative Medicine
Published in Elizabeth Combeer, The Final FRCA Short Answer Questions, 2019
Hepatopulmonary syndrome: pulmonary arteriovenous malformations causing right to left shunt. Causes platypnoea (shortness of breath relieved by lying down) and orthodeoxia (decreased oxygen saturations on sitting up).
Chronic Dyspnea
Published in Donald A. Mahler, Denis E. O’Donnell, Dyspnea, 2014
Alex H. Gifford, Donald A. Mahler
Platypnea develops in the upright position and improves in the recumbent position. It is frequently associated with orthodeoxia, the development of arterial oxyhemoglobin desaturation when upright. Platypneaorthodeoxia classically occurs because of right-to-left shunting through a patent foramen ovale (PFO), which has been reported with normal intracardiac pressures [42], but the phenomenon is also caused by pulmonary arteriovenous malformations (AVMs), hepatopulmonary syndrome, pulmonary embolism (PE), pericardial effusion, aortic dilatation, constrictive pericarditis, kyphoscoliosis, and autonomic dysfunction [43]. Uncommonly, right-to-left interatrial shunting causes platypnea after predominantly right-sided pneumonectomy that is antagonized by intravascular volume contraction [44]. Platypnea-orthodeoxia has been described when PFO coexists with kyphoscoliosis and aortic dilatation [45], pulmonary AVMs [46], and aneurysms of the thoracic aorta and atrial septum [47], which underscores the point that contemporaneous processes may be responsible for dyspnea.
Dyspnea in Parkinson’s disease: an approach to diagnosis and management
Published in Expert Review of Neurotherapeutics, 2020
Srimathy Vijayan, Bhajan Singh, Soumya Ghosh, Rick Stell, Frank L. Mastaglia
The circumstances under which dyspnea occurs is particularly noteworthy. While dyspnea occurring in the context of exercise or exertion is nonspecific and compatible with either a respiratory or cardiac etiology, a postural association may have more specific connotations. For example, orthopnea (recumbent breathlessness) is a common symptom of left ventricular failure and diaphragmatic weakness. Conversely, platypnea (dyspnea that improves when lying down and increases when sitting or standing) can occur with right-to-left shunts or ventilation-perfusion mismatching that may occur in pulmonary diseases or with orthostatic hypotension. The term ‘orthostatic dyspnea’ has been used to describe dyspnea when upright, resulting from ventilation-perfusion mismatch of the lung apices [28]. In the context of depression, anxiety, stress or during emotional states, dyspnea could be heightened or indeed represent a functional disorder. There may even be two or more causes for dyspnea in the same patient, and the clinician must remain open to all possibilities and investigate using a thorough and systematic approach.
Posture Dependent Hypoxia Following Lobectomy: The Achilles Tendon of the Lung Surgeon?
Published in Journal of Investigative Surgery, 2022
Athanassios Krassas, Aikaterini Tzifa, Stavroula Boulia, Kosmas Iliadis
However, some patients present a sudden onset of unexplained severe dyspnea in the upright position that resolves in the recumbent position (platypnoea or “flat breathing”). There coexists an acute drop of the arterial oxygen saturation in the upright posture improved in the supine position. The latest is called “orthodeoxia”. This clinical condition is called “Platypnoea-Orthodeoxia Syndrome (POS)”. The main cause of this phenomenon is an interatrial right-to-left shunt through a pre-operative asymptomatic Patent Foramen Ovalis (PFO) or Atrial Septal Defect (ASD).
Patent Foramen Ovale Closure, A Contemporary Review
Published in Structural Heart, 2018
Raouf Madhkour, Bernhard Meier
The platypnea-orthodeoxia syndrome is diagnosed rarely but it may be underdiagnosed. It occurs typically in the elderly with a PFO. It is a chronic condition, characterized by dyspnea and desaturation in the upright position. This position produces a right to left atrial shunt through the PFO. The etiology is most often related to an aging anatomy with spine shortening and pushed up or malfunctioning diaphragms, as well as to a prominent Eustachian valve in the right atrium, directing the flow from the inferior vena cava to the PFO.44