Unexplained dyspnea in an old patient with recurrent stroke: platypnea–orthodeoxia syndrome and evidence of patent foramen ovale

Platypnea–orthodeoxia is a syndrome characterized by dyspnea and hypoxemia in orthostatism relieved by supine position. This phenomenon is frequently associated with interatrial communication, mainly patent foramen ovale. The association of platypnea–orthodeoxia syndrome with recurrent stroke and patent foramen ovale is extremely uncommon. A 73-year-old woman experienced recurrent attacks of dyspnea after an ischemic stroke. Arterial blood gas analysis changes in upright and supine position confirmed the diagnosis of platypnea–orthodeoxia syndrome. Contrast-enhanced transthoracic echocardiography showed patent foramen ovale with atrial septal aneurysm and right-to-left shunt. Percutaneous closure of patent foramen ovale led to stabilization of blood oxygen saturation and resolution of dyspnea. Platypnea–orthodeoxia syndrome should be considered in patients with stroke and unexplained dyspnea. The diagnosis could lead to correction of an unknown cardiac defect and of potential risk factor for stroke.