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Refractory hypoxemia in right ventricular infarction: a case report.
Lindsay C Crawford1, Mukta Panda, Suresh Enjeti
1Department 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
Southern Medical Journal
|February 10, 2006
Summary
In myocardial infarction, hypoxemia can signal a right-to-left shunt through a patent foramen ovale. This case highlights a rare but critical diagnosis for internists to consider.
Area of Science:
- Cardiology
- Pulmonology
- Internal Medicine
Background:
- Right ventricular infarction presents with diverse clinical manifestations.
- Hypoxemia is a frequent symptom in myocardial infarction, often with multiple etiologies.
- Patent foramen ovale (PFO) is a potential, though often overlooked, cause of shunting.
Observation:
- A 74-year-old male with inferior myocardial infarction developed severe hypoxemia refractory to oxygen.
- Initial evaluation showed marked hypoxemia without respiratory distress.
- Transesophageal echocardiogram revealed an acute right-to-left shunt through a PFO.
Findings:
- The patient's hypoxemia was attributed to a right-to-left shunt via a previously undiagnosed PFO.
- This shunt occurred in the context of an acute inferior myocardial infarction.
- The condition, though sporadically reported, remains under-recognized.
Implications:
- This case underscores the importance of considering paradoxical embolism and shunting in myocardial infarction patients with hypoxemia.
- Physicians should be aware of PFO as a potential cause of refractory hypoxemia post-myocardial infarction.
- Recognizing this clinical scenario can lead to timely diagnosis and management, improving patient outcomes.