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Platypnea-orthodeoxia and progressive autonomic failure
J L Fox1, E Brown, J K Harrison
1Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
The American Review of Respiratory Disease
|December 1, 1989
Summary
Platypnea-orthodeoxia, a condition causing shortness of breath when upright, can occur in autonomic failure. This case shows it results from increased ventilation-perfusion mismatching and improves with fluids.
Area of Science:
- Cardiology
- Pulmonology
- Neurology
Background:
- Platypnea-orthodeoxia is typically associated with cardiac or pulmonary shunts.
- Severe lung disease is another known cause of platypnea-orthodeoxia.
Observation:
- A patient with progressive autonomic failure and minimal obstructive lung disease presented with platypnea-orthodeoxia.
- Symptoms included shortness of breath when assuming an upright position.
Findings:
- The patient's condition was attributed to an orthostatic increase in ventilation-perfusion (V/Q) mismatching.
- The V/Q mismatching worsened with upright posture.
Implications:
- This case expands the understanding of platypnea-orthodeoxia causes beyond shunts and severe lung disease.
- Autonomic failure should be considered in the differential diagnosis of platypnea-orthodeoxia.
- Fluid challenge demonstrated a potential therapeutic approach for this presentation.