title: Unexplained dyspnea in an old patient with recurrent stroke: platypnea-orthodeoxia syndrome and evidence of patent foramen ovale.
abstract: Platypnea-orthodeoxia is a syndrome characterized by dyspnea and hypoxemia in 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 ovale is extremely uncommon. A 73-year-old woman experienced recurrent attacks of dyspnea after an ischemic stroke. Arterial blood gas analysis changes in upright and supine position confirmed the diagnosis of platypnea-orthodeoxia syndrome. Contrast-enhanced transthoracic echocardiography showed patent foramen ovale with atrial septal aneurysm and right-to-left shunt. Percutaneous closure of patent foramen ovale led 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.
authors.affiliation: Neurology Section, Department of Neurosciences, University of Parma, Via Gramsci 14, 43100, Parma, Italy. monicaterina@yahoo.it
authors.forename: Monica
authors.initials: M
authors.lastname: Angelini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Lambru
authors.forename: Sara
authors.initials: S
authors.lastname: Montepietra
authors.forename: Massimo
authors.initials: M
authors.lastname: Riccardi
authors.forename: Carla
authors.initials: C
authors.lastname: Zanferrari
authors.forename: Ermelinda
authors.initials: E
authors.lastname: Bortone
mesh_terms: D000368:Aged; D001784:Blood Gas Analysis; D002545:Brain Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000175:diagnosis* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D054092:Foramen Ovale, Patent / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D010100:Oxygen / Q000097:blood; D012008:Recurrence; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology; D013577:Syndrome; D016896:Treatment Outcome
chemical_list: D010100:Oxygen