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What Causes Platypnea Without Orthodeoxia?

Posted on Thu, 30 Jun 2016

Question: What could cause someone to have platypnea without orthodeoxia?

Answered by Dr. Drkaushal85 (1 hour later)

Brief Answer:
Liver related diseases can cause platypnea.

Detailed Answer:
Thanks for your question on Healthcare Magic.
Platypnea is a term used for breathlessness in upright position and relieved by lying down position.
It is almost always associated with orthodeoxia. It is fall of oxygen saturation along with breathlessness in upright position and relieved by lying down position.
These two are commonly seen together.
Isolated Platypnea is rare entity.
It is commonly seen with early hepatopulmonary syndrome.
Sometimes, stress and anxiety can also cause breathlessness on upright position.
So please let me know
1. Is the patient alcoholic?
2. Is she having stress and anxiety?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wishing her good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (20 minutes later)

No alcohol use. Not stress related. I have these episodes of shortness of breath where it feels like I am gasping for air or have trouble taking a deep breath. If I lay flat it completely goes away. But I always maintain a normal oxygen saturation.

Answered by Dr. Drkaushal85 (2 minutes later)

Brief Answer:
Are you obese?

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
If oxygen saturation remains stable, no need to worry for major lung or liver related diseases.
Please let me know.
1. Are you obese?
2. What is your height and weight?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (6 minutes later)

I am 5'10 and 135 lbs. The shortness of breath I have can be so intense I have to go lay down in order to feel ok. The symptoms resolve VERY quickly after lying flat. I can't go up stairs or do activities that require bending or pulling and sometimes it happens when I start eating. Could some kind of shunt cause this to happen? Like it gets worse when standing and somehow fixes itself when lying flat?

Answered by Dr. Drkaushal85 (5 minutes later)

Brief Answer:
Since how long you are having these symptoms?

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
So you are not obese, so we can rule out obesity as a cause for this.
Yes, right to left shunt in heart can also cause platypnea. But then the symptoms should be from childhood.
So please let me know
1. Do you have any such symptoms in childhood?
2. Since how long you are having these symptoms?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (1 hour later)

I did not have these symptoms in childhood. I have had them for a little over a year. I had a transthoracic echo and it said a minimal left to right shunt but no right to left shunt with bubble study

Answered by Dr. Drkaushal85 (4 minutes later)

Brief Answer:
Left to right shunt will not cause this problem.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Since you are asymptomatic in childhood, I don't think any shunt or heart diseases is the cause for your symptoms.
And right ti left shunt can cause such symptoms, that to from childhood.
Left to right shunt can not cause such symptoms.
Please let me know
1. Do you have wheezing during breathlessness?
2. Do you have chest pain during such episodes?
3. Is this more common during daytime or night time?
4. Is there any relation between more episodes during menses?
5. Are any of your family members have similar symptoms?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (9 hours later)

I have been tested for asthma and it was negative. No wheezing or chest pain. Its worse in the morning right after getting out of bed. No relationship to menses. No family members with similar symptoms. The only thing that helps with it is when I lay flat. I was told I may have inappropriate tachycardia because my heart rate goes up to 160s when going up a couple flights of stairs. My resting heart rate is always low 60s. But rarely I will get shortness of breath when my heart rate is normal and I am sitting. Again if I lay flat I feel great. I was also told I have a flat blood pressure response. Oh and on PFTs the only thing that was abnormal was a low DLCO.

Answered by Dr. Drkaushal85 (12 minutes later)

Brief Answer:
Have you ever undergone Holter monitoring?

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
In my opinion, you should rule out arrhythmia (rhythm disturbances in heart).
You are having very high fluctuations in pulse rate.
So we should definitely rule out arrhythmia first.
So please let me know
1. Have you ever undergone Holter monitoring (24 hours continuous recording of ecg)?
Please reply me answer of above asked question, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (12 minutes later)

My rhythm stays normal. This is a very frustrating condition because I have been to many doctors and they just can't figure it out. They've talked about putting on a heart monitor for a week because all the 24 hr monitor showed was episodes of tachycardia with certain activities. The only thing I can think of is something with the blood return through my heart or lungs. Because it seems that it is hard for my body to overcome gravity being that my symptoms resolve when laying flat and sometimes I have to take these really deep breaths and I know that helps with venous return to the heart.

Answered by Dr. Drkaushal85 (16 minutes later)

Brief Answer:
Yes, you should get done Holter monitoring for 1 week.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Yes, I am also in favour of ecg monitoring of 1 week.
And honestly speaking, your case is not simple.
You can do deep breathing, no harm in it.
Hope I have solved your query. If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar