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Reversible Orthodeoxia and Platypnea Due to Right-to-Left Intracardiac Shunting Related to Pericardial Effusion

Eric A. Adolph, MD; William O. Lacy, MD; Yitzchak I. Hermoni, MD; Laura F. Wexler, MD; and Shahrokh Javaheri, MD
[+] Article, Author, and Disclosure Information

Requests for Reprints: Shahrokh Javaheri, MD, Pulmonary Section (111F). Veterans Affairs Medical Center, 3200 Vine Street, Cincinnati, OH 45220.

Current Author Addresses: Drs. Adolph and Wexler: Cardiology Section (111C), Veterans Affairs Medical Center, 3200 Vine Street, Cincinnati. OH 45220.

Drs. Lacy and Javaheri: Pulmonary section (111F), Veterans Affairs Medical Center. 3200 Vine Street. Cincinnati, OH 45220.

Dr. Hermoni: Cardiovascular Group, P. C., 2121 Fountain Drive, Suite H, Snellville, GA 30278.

Ann Intern Med. 1992;116(2):138-139. doi:10.7326/0003-4819-116-2-138
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The 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


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