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| {{CMG}} | | {{CMG}} |
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| ==Overview==
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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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| == 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 ===
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| '''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:'''
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| * [[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 ==
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| == History and Symptoms ==
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| *Note onset, persistance and associated symptoms
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| == Physical Examination ==
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| === Heart ===
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| An S3 gallop may be heard if [[LV failure]] is present
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| === Lungs ===
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| [[Rales]] will likely be present
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| == Laboratory Findings ==
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| *Labs include:
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| :*pulse oximetry
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| :*arterial blood gas
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| === Electrocardiogram ===
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| Should be performed to exclude [[MI]], RV strain, [[LV hypertrophy]] and [[cardiomyopathy]]
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| === Chest X Ray ===
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| Should be obtained to assess extent of [[pulmonary edema]]
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| === Echocardiography or Ultrasound ===
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| *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 == |