Journal of Cardiovascular Imaging

Korean Society of Echocardiography (한국심초음파학회)
권호 표지
DOI QR코드

DOI QR Code

EXERCISE-INDUCED INTRAPULMONARY ARTERIOVENOUS SHUNT IN A PATIENT COMPLAINING OF DYSPNEA DURING STRENUOUS EXERCISE

  • Kim, Tae-Jun (Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kim, Sung-Ai (Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Hong, Seong-Eun (Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Jung, Dong-Min (Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Choi, Nan-Young (Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kim, Yong-Kyun (Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Park, Seung-Ah (Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kim, Soon-Young (Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Park, Woo-Jung (Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine)
  • Received : 2013.09.07
  • Accepted : 2014.05.15
  • Published : 2014.06.27
⟨ Previous Next ⟩

Abstract

A 51-year-old highly fit man presented for dyspnea with strenuous aerobic exercise. The patient was asymptomatic and all tests were normal at rest. With increasing exercise intensity, he suddenly complained of dyspnea and showed a severe exercise-induced hypoxemia with an excessive alveolar-arterial oxygen tension difference. In agitated saline contrast echocardiography at peak exercise, a large amount of left to right shunt was identified after > 5 cardiac cycles, which suggests the presence of exercise-induced intrapulmonary arteriovenous shunt in this patient.

Keywords

References

  1. Dempsey JA, Wagner PD. Exercise-induced arterial hypoxemia. J Appl Physiol (1985) 1999;87:1997-2006. https://doi.org/10.1152/jappl.1999.87.6.1997
  2. Powers SK, Dodd S, Lawler J, Landry G, Kirtley M, McKnight T, Grinton S. Incidence of exercise induced hypoxemia in elite endurance athletes at sea level. Eur J Appl Physiol Occup Physiol 1988;58:298-302. https://doi.org/10.1007/BF00417266
  3. Wagner PD, Gale GE, Moon RE, Torre-Bueno JR, Stolp BW, Saltzman HA. Pulmonary gas exchange in humans exercising at sea level and simulated altitude. J Appl Physiol (1985) 1986;61:260-70. https://doi.org/10.1152/jappl.1986.61.1.260
  4. Vogiatzis I, Zakynthinos S, Boushel R, Athanasopoulos D, Guenette JA, Wagner H, Roussos C, Wagner PD. The contribution of intrapulmonary shunts to the alveolar-to-arterial oxygen difference during exercise is very small. J Physiol 2008;586:2381-91. https://doi.org/10.1113/jphysiol.2007.150128
  5. Lovering AT, Stickland MK, Kelso AJ, Eldridge MW. Direct demonstration of 25- and 50-microm arteriovenous pathways in healthy human and baboon lungs. Am J Physiol Heart Circ Physiol 2007;292:H1777-81. https://doi.org/10.1152/ajpheart.01024.2006
  6. Stickland MK, Lovering AT. Exercise-induced intrapulmonary arteriovenous shunting and pulmonary gas exchange. Exerc Sport Sci Rev 2006;34:99-106. https://doi.org/10.1249/00003677-200607000-00003
  7. Laurie SS, Yang X, Elliott JE, Beasley KM, Lovering AT. Hypoxia-induced intrapulmonary arteriovenous shunting at rest in healthy humans. J Appl Physiol (1985) 2010;109:1072-9. https://doi.org/10.1152/japplphysiol.00150.2010