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(Circulation. 1995;91:2284-2289.)
© 1995 American Heart Association, Inc.

Articles

Sixty-Eight-Year-Old Woman With Intermittent Hypoxemia

Wayne E. Dear, MD; Phebe Chen, MD; Eddy Barasch, MD; H. Vernon Anderson, MD; Annie T. Varughese, MD; Michael P. Macris, MD

From the Texas Heart Institute (W.E.D.), St Luke's Episcopal Hospital, and the Departments of Radiology (P.C.), Internal Medicine (Division of Cardiology) (E.B., H.V.A., A.T.V.), and Surgery (M.P.M.), The University of Texas Medical School at Houston, The University of Texas–Houston Health Science Center, Houston, Tex.

Correspondence to Herbert L. Fred, MD, Clinical Editor of Clinicopathological Conferences, Circulation Editorial Offices, St Luke's Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, Room B524 (MC1-267), Houston, TX 77030-2697.

	Case Presentation

 
A 68-year-old woman presented on September 30, 1994, with shortness of breath, nonproductive cough, and retrosternal chest tightness radiating to the neck. She believed her symptoms correlated with exposure to an unknown inhalant earlier that day, while she sat in her ophthalmologist's office. Eleven other patients and two ophthalmologists in the same clinic were exposed to the same "toxic inhalant" and reported similar symptoms including burning eyes. All were transported to the hospital for evaluation, and all but this patient were discharged from the emergency department in good condition.

The patient initially improved in the emergency department while lying supine with an O₂ saturation of 97% on 2 L/min O₂ by nasal cannula. However, when she stood up to make a telephone call, she noted acute increase in dyspnea, and her O₂ saturation fell to the low 80s and was minimally corrected with increased oxygen supplementation. Consequently, she was admitted to the intensive care unit for further evaluation and treatment.

She had had one previous episode of prolonged shortness of breath and fatigue approximately 3 months earlier while raking leaves in the hot summer sun. She attributed her symptoms to the heat. Otherwise, she had been fairly active at home, was able to perform daily chores without dyspnea or chest pain, denied paroxysmal nocturnal dyspnea or orthopnea, and noted only mild swelling of her ankles occasionally. She had no dyspnea or cyanotic spells during childhood and had tolerated two pregnancies without difficulty. She denied hemoptysis or pleuritic chest pain, had . . . [Full Text of this Article]

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