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. It is commonly measured according to the number of pillows needed to prop the patient up to enable breathing (Example: “3 pillow orthopnea”).

When a patient lies flat, pulmonary and venous pressure increases due to an increase in venous return to the lungs.

The condition is often due to left ventricular failure and/or pulmonary edema.

Orthopnea is associated with congestive heart failure in 95% of cases.

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’.

An EKG should be obtained to exclude myocardial infarction, right ventricular strain, left ventricular hypertrophy and cardiomyopathy.

A chest x ray should be obtained to assess extent of pulmonary edema.

Echocardiography can reveal structural problems of the heart and valves as well as LV function.