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Orthopnea

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

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”).

Pathophysiology

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

Causes

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

Epidemiology and Demographics

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

Diagnosis

History and Symptoms

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’.

Electrocardiogram

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

Chest X Ray

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

Echocardiography

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

References

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Historical Perspective

Historical Perspective

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References

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Classification

Classification

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Pathophysiology

Pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

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

References

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Causes

Causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Mugilan Poongkunran M.B.B.S [2]

Overview

Orthopnea is often observed among patients with left heart failure. Orthopnea can also occur in patients suffering from asthma and chronic bronchitis, as well as those with sleep apnea or panic disorder.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular Acute cardiac allograft rejection, aortic regurgitation, atrial fibrillation, arteriovenous fistula, Cardiac amyloidosis, cardiac aneurysm, cardiac sarcoidosis, cardiac tumors, cor pulmonale, diabetic heart disease, Eisenmenger syndrome, endomyocardial fibrosis, Fallot tetralogy, hypertrophic cardiomyopathy, idiopathic restrictive cardiomyopathy, stress cardiomyopathy, ischemic heart disease, left heart failure, mitral regurgitation, mitral valve stenosis, multifocal atrial tachycardia, myocardial infarction, patent ductus arteriosus, pericardial effusion, pericardiocentesis, peripartum cardiomyopathy, rupture of the papillary muscles, severe hypertension, STEMI, stress cardiomyopathy, tuberculous pericarditis
Chemical/Poisoning Beryllium, cadmium, carbon monoxide toxicity, coal worker pneumoconiosis, cobalt, fume inhalation, lead, mercury, nitrogen dioxide, organophosphates, selenium, silica, snake bite, sulfur dioxide
Dental No underlying causes
Dermatologic Dermatomyositis, mixed connective tissue disease
Drug Side Effect Amphetamines, anthracyclines, bleomycin, calcium channel blockers, carmustine, carnitine, cetuximab, chloroquine, clozapine, cyanides, cyclophosphamide, dasatinib, didanosine, gemcitabine, gemeprost, glatiramer acetate, glutaraldehyde, mitomycin C, nifedipine, nitrofurantoin, NSAIDs, paricalcitol, pentostatin, phenothiazines, protamine sulfate, regadenoson, rifampicin, ticagrelor, trastuzumab, zalcitabine, zidovudine
Ear Nose Throat Tracheolaryngobronchitis,
Endocrine Cushing’s disease, diabetes, goiter, hyperthyroidism, hypocalcemia, hypophosphatemia, hypothyroidism, liquorice, mineralocorticoids, pheochromocytoma, thyrotoxic myopathy
Environmental Beryllium, cadmium, carbon monoxide toxicity, coal worker pneumoconiosis, cobalt, fume inhalation, lead, liquorice, malnutrition, mercury, morbid obesity, organophosphates, silica, smoke inhalation, snake bite, sulfur dioxide
Gastroenterologic Aspiration of stomach contents, cirrhosis, pancreatitis, portopulmonary hypertension
Genetic Bulbospinal muscular atrophy, congenital impairment of lymphatic system, cystic fibrosis, Foster Kennedy syndrome, Friedreich’s ataxia, glycogen storage disease type II, GM2 gangliosidosis, hereditary hemochromatosis, hereditary spastic paraplegia, hereditary spinal muscular atrophy, inclusion body myositis, langerhans cell histiocytosis, late-onset Tay-Sachs disease, limb-girdle muscular dystrophy, lysosomal acid maltase deficiency, Pompe’s disease, myotonic dystrophy, patent ductus arteriosus, tetralogy of Fallot
Hematologic Congenital impairment of lymphatic system, disseminated intravascular coagulopathy, hemorrhagic shock, hereditary hemochromatosis, langerhans cell histiocytosis, lymphangiomyomatosis, septic shock, Severe anemia, transfusion reactions, Wegener granulomatosis
Iatrogenic Acute cardiac allograft rejection, anaphylaxis, aspiration of stomach contents, insulin treatment, IV fluid overload, neck surgery, pericardiocentesis, pneumothorax, radiation brainstem injury, radiation myelopathy, transfusion reactions
Infectious Disease Chagas disease, Guillain-Barré syndrome, herpes zoster, HIV, human monocytotropic ehrlichiosis, Lyme disease, pleural effusion, pneumocystis jiroveci, pneumonia, post polio syndrome, post-viral neuropathy, septic shock, toxocariasis, tropical pulmonary eosinophilia, tuberculous pericarditis, viral cardiomyopathy, yersinia pestis
Musculoskeletal/Orthopedic Cervical spondylosis with compressive radiculopathy and myelopathy, dermatomyositis, Lambert-Eaton Syndrome, inclusion body myositis, limb-girdle muscular dystrophy, mixed connective tissue disease, myasthenia gravis, myotonic dystrophy, polymyositis post polio syndrome, progressive muscular atrophy, rheumatoid arthritis
Neurologic Amyotrophic lateral sclerosis, bilateral diaphragmatic paralysis, bulbospinal muscular atrophy, central sleep apnea, cervical spondylosis with compressive radiculopathy and myelopathy, Lambert-Eaton syndrome, Foster Kennedy syndrome, Friedreich’s ataxia, GM2 gangliosidosis, Guillain-Barré syndrome, hereditary spastic paraplegia, hereditary spinal muscular atrophy, intraspinal tumors, late-onset Tay-Sachs disease, monomelic (benign focal) amyotrophy, motor neuron syndromes in cancers, multifocal motor neuropathy, multiple sclerosis, myasthenia gravis, myotonic dystrophy, neurogenic pulmonary oedema, phrenic nerve injury due to stretching or cooling during cardiac surgery, Post-polio progressive muscular atrophy, post-viral neuropathy, preeclampsia, primary lateral sclerosis, progressive bulbar palsy, progressive muscular atrophy, radiation brainstem injury/radiation myelopathy, stroke
Nutritional/Metabolic Glycogen storage disease type II, hypocalcemia, hypophosphatemia, hypoproteinemia, lysosomal acid maltase deficiency, Pompe’s disease, wet beri-beri,
Obstetric/Gynecologic Eclampsia, peripartum cardiomyopathy, preeclampsia, pregnancy, premenstrual syndrome
Oncologic Bronchogenic carcinoma, cardiac tumors, intraspinal tumors, malignant pleural mesothelioma, motor neuron syndromes in cancers
Ophthalmologic No underlying causes
Overdose/Toxicity Bleomycin, cocaine, cyanides, mineralocorticoids, narcotic overdose
Psychiatric Panic attack, stress cardiomyopathy
Pulmonary Acute respiratory distress syndrome, altitude sickness, asthma, bilateral diaphragmatic paralysis, bronchiectasis, bronchiolitis obliterans, bronchitis, bronchogenic carcinoma, bronchogenic cyst, bronchopulmonary dysplasia, bronchospasm, central sleep apnea, chronic obstructive pulmonary disease, Churg-Strauss syndrome, cor pulmonale, CREST syndrome, cystic fibrosis, diffuse panbronchiolitis, Eisenmenger syndrome, empyema, extrinsic allergic alveolitis, fibrosing alveolitis, cryptogenic, goodpasture syndrome, idiopathic pulmonary haemosiderosis, interstitial lung disease , malignant pleural mesothelioma, near-drowning, pleural effusion, pneumonia, pneumothorax, polyarteritis nodosa, portopulmonary hypertension, pulmonary alveolar proteinosis, pulmonary edema, pulmonary embolism, pulmonary fibrosis, pulmonary hypertension, pulmonary veno-occlusive disease, pulmonic stenosis, respiratory failure, sclerosing mediastinitis, systemic lupus erythematosus(shrinking lung syndrome), smoke inhalation, tracheolaryngobronchitis, transient tachypnea of the newborn, tropical pulmonary eosinophilia
Renal/Electrolyte Nephritic syndrome, nephrotic syndrome, renal artery stenosis, renal failure, Uremia
Rheumatology/Immunology/Allergy Acute cardiac allograft rejection, anaphylaxis, asthma, cardiac sarcoidosis, Churg-Strauss syndrome, CREST syndrome, cytokine release syndrome, dermatomyositis, Lambert-Eaton Syndrome, Goodpasture syndrome, mixed connective tissue disease, myasthenia gravis, polyarteritis nodosa, polymyositis, rheumatoid arthritis, sclerosing mediastinitis, systemic lupus erythematosus(shrinking lung syndrome), systemic sclerosis, Wegener granulomatosis
Sexual No underlying causes
Trauma Blunt neck trauma, head injury, hemorrhagic shock, neck surgery, rib fracture
Urologic No underlying causes
Miscellaneous Altitude sickness, amyloid cardiomyopathy, heavy alcohol intake, malnutrition, morbid obesity, near-drowning

Causes by Organ System developed by WikiDoc.org, Copyleft 2013

Causes in Alphabetical Order

References

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Differentiating Orthopnea from other Diseases

Differentiating Orthopnea from other Diseases

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Epidemiology and Demographics

Epidemiology and Demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Orthopnea indicates heart failure in almost 95% of cases.

References

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Risk Factors

Risk Factors

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Natural History, Complications and Prognosis

Natural History, Complications and Prognosis

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Diagnosis

Diagnosis

History and Symptoms | Electrocardiogram | Physical Examination | Laboratory Findings | Chest X Ray | CT | Echocardiography | Other Imaging Findings | Other Diagnostic Studies

Treatment

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case Studies

Case #1

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