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| | {{Orthopnea}} |
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| | '''For patient information, click [[Orthopnea (patient information)|here]]''' |
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| '''Orthopnea''' (Greek from ''ortho'', straight + ''pnoia'', breath) is [[dyspnea]] which occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair. Orthopnoea is a symptom of [[heart failure]]. It can also occur in those with [[asthma]] and chronic [[bronchitis]], as well as those with [[sleep apnea]] or [[panic disorder]]. The condition is often due to [[left ventricular failure]] and/or [[pulmonary edema]]. It is also associated with [[Polycystic Liver Disease]].
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| Patients with orthopnoea often complain of waking up suddenly during the night 'unable to breathe' if they have slipped down from their pillows into the supine position. They may run to the window to 'get some air'.
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| It is commonly measured according to the number of pillows needed to prop the patient up to enable breathing (Example: "3 pillow orthopnea").
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| See also: [[Paroxysmal Nocturnal Dyspnea]] which means that a patient wakes up short of breath.
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| == Epidemiology and Demographics ==
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| Orthopnea indicates [[heart failure]] in almost 95% of cases.
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| ==Pathophysiology==
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| When a patient lies flat, pulmonary and venous pressure increases due to increase in venous return to the lungs.
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| == Differential Diagnosis ==
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| Othopnea is often observed among patients with [[left heart failure]] the causes of which are included in the list below.
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| In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
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| === Left Ventricular Failure === | | == [[Orthopnea overview|Overview]] == |
| '''Most Common Causes:'''
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| * [[Aortic Regurgitation|Aortic regurgitation]]
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| * [[Aortic Stenosis|Aortic stenosis]]
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| * [[Hypertension]]
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| * [[Mitral Regurgitation|Mitral regurgitation]]
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| * [[Myocardial ischemia]]
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| '''Expanded List of Causes:'''
| | == [[Orthopnea historical perspective|Historical Perspective]] == |
| * [[Atrial fibrillation]]
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| * [[Alcoholism]]
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| * [[Anemia]]
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| * [[Angina]]
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| * [[Aortic Regurgitation|Aortic regurgitation]]
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| * [[Aortic Stenosis]]
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| * [[Arteriovenous fistula]]
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| * [[Beriberi]]
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| * Cardiac [[aneurysm]]
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| * [[Cardiomyopathy]]
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| * [[Constrictive pericarditis]]
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| * [[Drugs]], [[toxin]]s
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| * [[Hypertension]]
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| * [[Hyperthyroidism]]
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| * [[Hypovolemia]]
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| * [[Hypoxia]]
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| * Mediastinal tumors
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| * [[Mitral Regurgitation]]
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| * [[Myocardial Infarction]]
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| * [[Paget's Disease]]
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| * [[Pancoast's Tumor]]
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| * [[Pericardial effusion]]
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| * [[Pericardial tamponade]]
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| * Perimyocarditis
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| * [[Protein deficiency]]
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| * [[Restrictive cardiomyopathy]]
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| * [[Rupture of the papillary muscles]]
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| * [[Sepsis]]
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| * Superior Vena Cava Thrombosis
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| == Diagnosis == | | == [[Orthopnea classification|Classification]] == |
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| == History and Symptoms == | | == [[Orthopnea pathophysiology|Pathophysiology]] == |
| *Note onset, persistance and associated symptoms
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| == Physical Examination == | | == [[Orthopnea causes|Causes]] == |
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| === Heart === | | == [[Orthopnea differential diagnosis|Differentiating Orthopnea from other Diseases]] == |
| An S3 gallop may be heard if [[LV failure]] is present
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| === Lungs === | | == [[Orthopnea epidemiology and demographics|Epidemiology and Demographics]] == |
| [[Rales]] will likely be present | |
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| == Laboratory Findings == | | == [[Orthopnea risk factors|Risk Factors]] == |
| *Labs include:
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| :*pulse oximetry
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| :*arterial blood gas
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| === Electrocardiogram === | | == [[Orthopnea natural history, complications and prognosis|Natural History, Complications and Prognosis]] == |
| Should be performed to exclude [[MI]], RV strain, [[LV hypertrophy]] and [[cardiomyopathy]]
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| === Chest X Ray === | | == [[Orthopnea diagnosis|Diagnosis]] == |
| Should be obtained to assess extent of [[pulmonary edema]]
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| === Echocardiography or Ultrasound ===
| | [[Orthopnea history and symptoms|History and Symptoms]] | [[Orthopnea electrocardiogram|Electrocardiogram]] | [[Orthopnea physical examination|Physical Examination]] | [[Orthopnea laboratory findings|Laboratory Findings]] | [[Orthopnea chest x ray|Chest X Ray]] | [[Orthopnea CT|CT]] | [[Orthopnea echocardiography|Echocardiography]] | [[Orthopnea other imaging findings|Other Imaging Findings]] | [[Orthopnea other diagnostic studies|Other Diagnostic Studies]] |
| *Reveals any structure problems of the heart, valves and LV function
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| === Other Diagnostic Studies ===
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| *Pulmonary function tests
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| *BNP to distinguish CHF
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| == Treatment == | | == Treatment == |
| Supplemental oxygen
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| === Acute Pharmacotherapies ===
| | [[Orthopnea medical therapy|Medical Therapy]] | [[Orthopnea surgery|Surgery]] | [[Orthopnea primary prevention|Primary Prevention]] | [[Orthopnea secondary prevention|Secondary Prevention]] | [[Orthopnea cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Orthopnea future or investigational therapies|Future or Investigational Therapies]] |
| *[[CHF]]
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| :*[[nitrates]]
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| :*loop [[diuretic]]s
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| :*IV [[morphine]]
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| :*[[ACE inhibitors]]
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| :*[[digoxin]]
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| Valve disease:
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| :*[[ACE inhibitors]]
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| :*[[beta blockers]]
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| *Asthma
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| :*[[Albuterol]]
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| *[[COPD]]
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| :*Inhaled vasodilators
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| === Indications for Surgery === | | == Case Studies == |
| *Valve disease
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| :*valve replacement
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| :*valve balloon
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| *Pleural effusion
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| :*thoracentesis
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| == References ==
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| {{reflist|2}}
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| == Acknowledgements ==
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| The content on this page was first contributed by {{CMG}}
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| List of contributors:
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| == Suggested Reading and Key General References ==
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| == Suggested Links and Web Resources ==
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| == For Patients ==
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| {{SIB}}
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| | : [[Orthopnea case study one|Case #1]] |
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| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| | [[Category:Symptoms]] |
| [[Category:Signs and symptoms]] | | [[Category:Signs and symptoms]] |
| [[Category:Pulmonology]] | | [[Category:Pulmonology]] |
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