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Uncommon late presentation of platypnea-orthodeoxia syndrome

Journal of Geriatric Cardiology 2015年第6期12卷 687-689页

作者： Laura Toffetti Marco Centola Laura Massironi cristina pipia Fabiano Di Marco Alessandro Colombo Emanuela Piccaluga Division of Cardiology Ospedale San Paolo University of Milan Italy Divison of Internal Medicine Ospedale San Paolo Italy Division of Respiratory Medicine University of Milan Italy Division of Cardiology Azienda Ospedaliera 'Luigi Sacco ' Milan Italy

A 79-year-old man presented with progressive dyspnea,gradually worsening over a period of several weeks. His past medical history included hypertension, chronic hepatitis C without cirrhosis, ischemic stroke occurred at the age of 68 and chronic obstructive pulmonary disease (COPD) caused by long-term cigarette smoking. The patient was alert and oriented and not in acute distress. The physical examination of the chest revealed decreased breath sounds at the bases of the lungs, without crackles or wheezes. Heart sounds were regular without murmurs. The respiration rate was normal. Extremities had no cyanosis, clubbing or oedema. The 12-lead electrocardiogram showed sinus rhythm with normal heart rate and non-specific T wave changes in D1, D2 and V5-V6. The chest radiograph revealed bilateral hilar prominence. Baseline peripheral capillary oxygen saturation (SpO_2) measured by standard pulse oximetry was 89%. A face mask was placed, delivering oxygen at 6 L/min. The subsequent arterial blood gas analysis provided information on the following parameters: pH 7.41, PaCO_2 34 mmHg, PaO_2 64 mmHg, SaO_2 91%. The full blood examination was normal, except for elevated C-reactive protein(50 mL/L, normal range < 10 mg/L) and D-dimer (782 ng/mL, normal range ≤ 270 ng/mL). A pulmonary embolism was suspected and a computed tomography pulmonary angiogram was then performed. No filling defects within the lumen of the pulmonary arterial branches were detected,neither were pleural effusion or pulmonary inflammatory infiltrates. A transthoracic echocardiogram (TTE) showed normal left ventricular ejection fraction, grade I diastolic dysfunction, normal heart valves, normal pulmonary pressure(systolic pulmonary artery pressure of 27 mmHg) and moderate enlargement of the ascending aorta (sinuses of Valsalva diameter of 49 mm). The patient was treated with a standard therapy for the acute exacerbation of COPD. Serum inflammatory markers progressively decreased. Nevertheless,episodes of dy

关键词：慢性阻塞性肺病综合征慢性阻塞性肺疾病晚期血症低氧呼吸困难丙型肝炎

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