“Worse With Sitting”: A Case of Severe Hypoxia Due to an Undiscovered Patent Foramen Ovale

TL;DR

An elderly woman with severe hypoxia was found to have an undiagnosed patent foramen ovale, highlighting a rare but serious non-neurological complication of this condition.

Contribution

This case highlights a rare presentation of PFO causing severe pulmonary symptoms rather than neurological issues.

Findings

A large PFO was identified as the cause of severe hypoxia in an elderly female patient.

The patient required high respiratory support due to the PFO-related condition.

This case emphasizes the need to consider PFO in non-neurological clinical presentations.

Abstract

Patent foramen ovale (PFO) is a cardiac shunt that results when the foramen ovale fails to close after birth. While it is relatively common, most cases are asymptomatic. The primary clinical implication of PFO is an increased risk of cryptogenic stroke. Accordingly, most literature addresses PFO through the lens of treating/preventing neurological disease. Much less research has been devoted to the minority of patients who suffer pulmonary and cardiovascular symptoms that are directly caused by their PFO. Here, we discuss a case of an elderly female patient presenting with hypoxia requiring high respiratory support, later found to be the result of a large, previously unknown PFO.