A Newly Described Cause Platypnea in a patient with COPD evolveed during the subacute onset of an ileus.

A Newly Described Cause

Platypnea in a patient with COPD evolveed during the subacute onset of an ileus. Arterial house gas studies failed to document orthodeoxia. Routine treatment of COPD failed to analyze the patient's positional dyspnea, further the dyspnea rapidly resolved following resolution of the ileus. The authors postulate that impaired abdominal muscle contraction in the upright position secondary to the ileus was responsible for the disentanglement of platypnea.

Dyspnea in the upright position that is relieved according to resuming the supine position has been described in patients with sharp COPD and has been period of timeed "platypnea."[1] Platypnea has also been described in patients with a history of a right-to-left intracardiac switch true vascular lung shunts, pneumonectomy or following recuperation from adult respiratory distress syndrome[2-5] Without these obvious described processe and particularly in the intensive care unit, relentless positional dyspnea may provide a therapeutic dilemma.

We instant the case of patient with a history of COPD on the contrary no history of positional dyspnea who instanted with an acute onset of strong platypnea. None of the above-mentioned causes of platypnea were identified, and sole after the diagnosis and treatment of a slowly developing adynamic ileus her symptom of dyspnea in the upright position resolve

CASE REPORT

A 73-year-old white woman with oxygen-dependent COPD ([FEVsub1] = 054 L) quick in emergenciesed with a 5-day history of upper respiratory tract symptoms and increasing shortness of breath. She had mild left ventricular dysfunction, hypertension, and hypothyroidism. Her medications forward admission included theophylline, ipratropium bromide, albuterol, and levothyroxine sodium (Synthroid, avails Pharmaceuticals).

The patients existinged in moderate to marked respiratory distress with obivous use of her accessory muscles. Her oral temperature was 382 [degrees] C respiratory rate was 24 breaths/min, beating [i]or[/i] throbbing of an artery was 140 beats/min, and kindred pressure was 180/60 mm Hg Jugular venous distention was absent. There were decreased breath entires throughout with diffuse expiratory wheezes. Cardiac examination revealed a tachycardic regular rhytm and distant heart wholes Bowel sounds were ready The rest of the physical examination findings were normal. The admission arterial vital fluid gas analysis revealed a pH of 723 a [PaCO.sub.2] of 54 mm Hg and a [PaO.sub.2] of 73 mm Hg forward 3 L/min of oxygen delivered by way of nasal cannula. The chest roentgenogram revealed increased bronchial markings moreover no cardiomegaly, infiltrates, or effusions.

The patient was initially treated with corticosteroids, aminophlline, antibiotics, [beta.sub.2]-agonists, and ipratropium bromide. Initial improvement occurr in the first 24 h nevertheless it soon became readily apparent that she stomached from marked positional dyspnea. Any mental action to a position greater than 45 ]degrees] from supine riseed in tachycardia, tachypnea, and accurate dyspnea. She began complaining of constipation, anorexia, and intermittent nausea, which was initially thinking to be secondary to a high-normal theophylline on a level An echocardiogram, to expect for right-to-left shunting, did not reveal any obvious atrial septal default To document the mien or absence of orthodeoxia, arterial relations gas samples were obtained with the patient supine, at 45 [degrees] and upright. There was no orthodeoxia accompany her platypnea, further she was unable to tolerate sitting in the upright position for more than 3 min.

The patient's symptoms of anorexia, nausea, and constipation became more intense, and were subsequently accompained according to abdominal pain with tenderness to palpation. A flat plate film of the nasogastric tube was inserted to treat the adynamic ileus, which in survey had probably been present to a certain degree since the second day of her hospitalization. Approximately 2500 ml of fluid was remov in the nearest 12 h. Her abdominal complaints resolv and, more significantly, her platypnea ceased.

DISCUSSION

Platypnea in a patient with plain COPD was first described from Altman and Robin.[1]. They hypothesized that the combination of increased alveolar compressing and lower pulmonary artery urgency in the upper lung regions during the upright position cause regions that act as respiratory dead space (diffuse climate I phenomenon). Michel et al,[6] reporting forward a patient with COPD and platypnea, flet that the platypnea was related to strict hypoxia as a result of poor regional ventilation-perfusion matching, which was a consecution of a poor hypoxic vascular adaptive mechansim.

Our patient certainly had sharp COPD, but no previous symptoms of platypnea. The patient's positional dyspnea be seened to worsen as the ileus increaseed and it was not until we treated the ileus that the platypnea dramatically resolv Because the ileus was not readily apparent initially, and because the platypnea was in such a manner new in onset, we attempted to lordship out other causes of platypnea. Although a tilt-table two-dimensional echocardiogram with peripheral venous contrast medium was not performed to command out a right-to-left shunt,[2] no obvious shunting was noted forward routine echocardiography nor did orthodeoxia come about with the platypnea. Another cause of platypnea, authentic vascular lung shunts secondary to chronic liver disease of congenital arteriovenous fistulas, has also been described,[3] nevertheless our patient had no evidence of either.

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