Case report: Anxiety and depression as initial symptoms in a patient with acute hypoxia and patent foramen ovale

Frontiers in Psychiatry

Psychiatry

Xiaoyan Zhai¹  Aihua Ni¹  Ronghong Jiao²  Xueyi Wang³ 

[1] Department of Clinical Psychology, Hebei General Hospital, Shijiazhuang, China;Department of Ultrasound, Hebei General Hospital, Shijiazhuang, Hebei, China;Psychiatric Department of The First Hospital of Hebei Medical University, Institute of Mental Health of Hebei Medical University, Shijiazhuang, Hebei, China;

关键词: anxiety;    depression;    hypoxia;    right-to-left shunt;    patent foramen ovale;    agitated;   

DOI  :  10.3389/fpsyt.2023.1229995

 received in 2023-05-27, accepted in 2023-08-07,  发布年份 2023

来源: Frontiers

【 摘 要 】

The prevalence of patent foramen ovale (PFO) is 15–35% among adults. The role of right-to-left shunting through the PFO, anxiety, depression, and hypoxemia in the systemic circulation remains poorly understood. Herein, we present the case of a 52-year-old woman with no heart or lung disease, who was admitted due to anxiety for 5 months and had symptom exacerbation with dizziness for 4 days and presented with cyanosis. She was noted to have acute hypoxemia, with an oxygen saturation of 94.48% on room air, and arterial blood gas showed an oxygen tension of 65.64 mmHg. Agitated saline contrast echocardiography showed right-to-left shunting due to PFO. Arteriovenous fistula, pneumonia, pulmonary embolism, pulmonary hypertension, congestion peripheral cyanosis, ischemic peripheral cyanosis, and methemoglobin were excluded. Additionally, the patient improved by taking Paroxetine, Oxazepam, and Olanzapine. Her oxygen tension returned to 90.42 mmHg, and her symptoms resolved. In the case of severe anxiety and depression, right-to-left shunting through the PFO may cause acute systemic hypoxemia via a flow-driven mechanism, occasionally manifesting as cyanosis. When anxiety improved, hypoxia also improved. Thus, the treatment of anxiety and depression seems effective in improving hypoxemia. Notably, this is a rare report, and we hope to draw the attention of psychosomatic specialists, psychiatrists, and clinicians to seek the relationship between anxiety appearing as acute stress and PFO. This may be a new therapeutic method for treating severe anxiety disorder.

【 授权许可】

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Copyright © 2023 Zhai, Jiao, Ni and Wang.