title: Refractory hypoxemia in right ventricular infarction: a case report.
abstract: Right ventricular infarction has many clinical features. Although hypoxemia is a common presenting symptom with multiple causes in the setting of myocardial infarction, the authors present a case resulting from an acute right-to-left shunt secondary to a previously dormant patent foramen ovale. A 74-year-old male presented to the hospital after feeling unwell for the previous 2 days. Initial evaluation revealed marked hypoxemia without respiratory distress. Electrocardiographic findings and cardiac seromarkers revealed a completed inferior myocardial infarction. The patient's hypoxemia was refractory to 100% oxygen, indicating a right-to-left shunt. A transesophageal echocardiogram confirmed clinical suspicions for a right-to-left shunt through a patent foramen ovale. Despite sporadic reports in the literature, this still is a poorly recognized clinical condition. The authors review a case report that will enable the general intemist to consider a right-to-left shunt in the setting of hypoxemia in myocardial infarction.
authors.affiliation: Department of Medicine, Pulmonary Division, University of Tennessee College of Medicine-Chattanooga Unit, 960 East Third Street, Suite 208, Chattanooga, TN 37403, USA. lindsay_craw@hotmail.com
authors.forename: Lindsay C
authors.initials: LC
authors.lastname: Crawford
authors.forename: Mukta
authors.initials: M
authors.lastname: Panda
authors.forename: Suresh
authors.initials: S
authors.lastname: Enjeti
mesh_terms: D000368:Aged; D001784:Blood Gas Analysis; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging; D006352:Heart Ventricles; D006801:Humans; D000860:Hypoxia / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications* / Q000175:diagnosis