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Platypnoea Orthodeoxia Syndrome (POS)
Platypnoea Orthodeoxia Syndrome (POS)
 Platypnoea refers to worsening of dyspnoea on assuming
an
upright posture from sup...
Etiology
 PFO and other interatrial defects
 Pericardial effusion
 Constrictive pericarditis
 Emphysema
 Amiodarone i...
Clinical features
 Dyspnoea with or without cyanosis in the upright posture
which relieves on recumbent posture.
 May be...
Pathophysiology
 Two components are required for the development of
POS.
 An interatrial communication like PFO, ASD or ...
Diagnosis
 Definitive diagnosis can be made by Echocardiography
with
doppler mode and contrast echocardiography -
transth...
Treatment
 Treatment depends on the cause.
 Percutaneous or surgical closure of the defect is the
curative therapy for i...
THANK YOU
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Platypnoea orthopnoea syndrome

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Platypnoea orthopnoea syndrome

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Platypnoea orthopnoea syndrome

  1. 1. Platypnoea Orthodeoxia Syndrome (POS)
  2. 2. Platypnoea Orthodeoxia Syndrome (POS)  Platypnoea refers to worsening of dyspnoea on assuming an upright posture from supine.  Orthodeoxia refers to worsening of arterial PaO2 on upright postures.  First described by Butchell et al in 1949  Total cases reported - 188Kubler P, Gibbs H, Garrabhy P; Heart 2000
  3. 3. Etiology  PFO and other interatrial defects  Pericardial effusion  Constrictive pericarditis  Emphysema  Amiodarone induced pulmonary fibrosis,  Pulmonary embolism  Post pneumonectomy  Hepatopulmonary syndrome  Stroke Seward JB et al. Platypnea orthodeoxia: clinical profile, diagnostic workup, manage and report of 7 cases. Mayo Clin Proc 1984;59:221–31
  4. 4. Clinical features  Dyspnoea with or without cyanosis in the upright posture which relieves on recumbent posture.  May be associated with diaphoresis, tachypnoea and tachycardia.  Initial assessment of the patients should be done with pulse oximetry and ABG analysis in both supine and upright posture. Rodriguez, Roisin R, Agusti AG, Roca J et al, Thorax. 1992 Nov;
  5. 5. Pathophysiology  Two components are required for the development of POS.  An interatrial communication like PFO, ASD or atrial septal aneurism with septal fenestration or intrapulmonary shunting as in hepatopulmonary syndrome.  Second a functional component that promotes abnormal shunting when the patient rises from recumbent to upright position like deformity in the atrial septum or in the right atrial anatomy that increases the streaming of blood from the inferior venacava through the defect. Robin ED et al: Platypnea related to orthodeoxia caused by true vascular lung shun N Engl J Med 294:941-943, 1976
  6. 6. Diagnosis  Definitive diagnosis can be made by Echocardiography with doppler mode and contrast echocardiography - transthoracic and transoesophageal with postural manoeuvres.  Intrapulmonary shunts can be identified by contrast enhanced echocardiography, perfusion scan(scintigraphy) with macroaggregated albumin and pulmonary arteriography. Cheng et al, Platypnea-orthodeoxia syndrome: etiology, differential diagnosis, and
  7. 7. Treatment  Treatment depends on the cause.  Percutaneous or surgical closure of the defect is the curative therapy for intracardiac shunts.Associated anatomical defects may require surgical correction.  Underlying pulmonary diseases should be treated.  In patients with hepatopulmonary syndrome, liver transplantation is the only curative treatment. Akin et al, The platypnea-orthodeoxia syndrome. European Review for Medical and
  8. 8. THANK YOU

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