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Platypnoea-orthodeoxia syndrome: the importance of the patient’s posture for diagnosis
  1. Carla Pereira Fontes1,
  2. Samuel Barbosa Fonseca1 and
  3. Mário Santos2
  1. 1Internal Medicine, Centro Hospitalar de Entre o Douro e Vouga EPE, Santa Maria da Feira, Portugal
  2. 2Cardiology, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
  1. Correspondence to Dr Carla Pereira Fontes; carla.pfts{at}


Platypnoea-orthodeoxia syndrome (POS) is a rare condition characterised by the association of dyspnoea and arterial oxygen desaturation induced by standing and relieved by recumbency. The precise mechanism remains poorly understood, but it appears to involve both anatomical and functional components producing a significant right-to-left shunting under certain postural conditions. This syndrome is associated with either intracardiac or extracardiac aetiologies, and the diagnosis depends on high clinical suspicion. Intracardiac shunt is the most common cause of POS and can be identified through echocardiography with bubble study. We report the case of a patient with POS secondary to a paradoxical shunt through the patent foramen oval, whose definitive diagnosis was only possible with contrasted transthoracic echocardiography in the sitting and standing positions.

  • interventional cardiology
  • clinical diagnostic tests

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  • Contributors CPF was involved in drafting the article. SBF and MS were involved in revising the article critically for important intellectual content. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.