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Eosinophilic Endomyocardial Disease Presenting as Cyanosis, Platypnea, and Orthodeoxia

R. Scott Wright, MD; Robert D. Simari, MD; Thomas A. Orszulak, MD; William D. Edwards, MD; Gerald J. Gleich, MD; and Guy S. Reeder, MD
[+] Article, Author, and Disclosure Information

Grant Support: In part by the National Institutes of Health (grant 15231) and the Mayo Foundation.

Requests for Reprints: R. Scott Wright, MD, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Current Author Addresses: Drs. Wright, Simari, Orszulak, Edwards, Gleich, and Reeder: Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Ann Intern Med. 1992;117(6):482-483. doi:10.7326/0003-4819-117-6-482
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This excerpt has been provided in the absence of an abstract.

Orthodeoxia and platypnea refer to arterial desaturation and dyspnea that occur with assumption of an upright posture and are relieved by recumbency (1). We describe a unique presentation of eosinophilic endomyocardial disease as cyanosis, orthodeoxia, and platypnea, all secondary to massive right-to-left shunting across a previously asymptomatic atrial septal defect.

Case Report: A 39-year-old farm laborer noted a dry cough and fatigue that quickly progressed to near syncope and rest dyspnea over an 8-week period. His arterial blood gas suggested anatomic right-to-left shunting with a Pao2 (arterial partial pressure of oxygen) of 40 mm Hg on a 100% close-fitting oxygen


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