Platypus and Platypnea: Greek for Flat-Foot and Flat Breathing

While we ramp up this site, we’ll be presenting some past morning report pearls:
Report Pearls
1. Orthodeoxia/Platypnea
  • Platypnea: An increase in dyspnea induced by moving into an upright position and relieved by recumbency
  • Orthodeoxia: Refers to decrease in arterial oxygen or aterial oxyhemoglobin when a patient moves into an upright position from a recumbent position
  • Caused by right-to-left shunt and seen in…
    • Hepatopulmonary Syndrome
    • Post-pneumonectomy
    • Recurrent PE’s
    • Atrial Septal Defects
    • Chronic Lung Disease
2. Vocal Cord Dysfunction (VCD) is characterized by full or partial closure of the vocal chords, usually occuring during inhilation but can occur during expiration.  Rarely results in decreased oxygen saturation.
  • Presentation: SOB, dyspnea, wheezing, coughing, tighness in throat, and stridor.  Can mimic asthma, anaphylaxis, PTX, or PE. 
  • Diagnosis: Direct visualization with laryngoscopy
  • Treatment is multidisciplinary with breathing exercises, psychoterhapy, or anti-antiety/depressant medications.  Acute treatments include heliox, IPPV, or CPAP and severe cases may require tracheotomy.
3. Signs of Right Heart Strain on ECG include ST Depressions and/or T wave inversions in leads corresponding to the RV (V1 – V3 and inferior leads II, III, and aVF with III being the most pronounced).
  • DDx for Right Heart Strain
    • PE
    • Mitral Stenosis
    • Pulmonary Embolism
    • Chronic Lung Disease
    • Congenital heart disease (e.g. Tetalogy of Fallot, pulmonary stenosis)
    • Arrhthmogenic RV cardiomyopathy

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