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Health Dictionary

Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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PND

Introduction

Synonyms and keywords: Cardiac asthma; PND

Overview

Overview

Paroxysmal nocturnal dyspnea (PND) is defined as sudden, severe shortness of breath at night that awakens a person from sleep, often with coughing and wheezing. It is most closely associated with congestive heart failure. PND commonly occurs several hours after a person with heart failure has fallen asleep. PND is often relieved by sitting upright, but not as quickly as simple orthopnea. Also unlike orthopnea, it does not develop immediately upon lying down.

Historical Perspective

Historical Perspective

It was first described by Charles Lepois in the 1500s.

Pathophysiology

Pathophysiology

PND is caused by increasing amounts of fluid entering the lung during sleep and filling the small, air-filled sacs (alveoli) in the lung responsible for absorbing oxygen from the atmosphere. This fluid typically rests in the legs (peripheral edema) during the day when the individual is upright. At night, when recumbent for an extended period, this fluid is reabsorbed, increasing total blood volume and blood pressure, leading to pulmonary hypertension in people with underlying heart failure. The consequent pulmonary hypertension leads to the accumulation of fluid in the lungs, or pulmonary edema.

Causes

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 decompensated heart failure, aortic regurgitation, aortic stenosis, atypical myocardial infarction, cardiac amyloidosis, cardiac ischemia, cardiac tamponade, cardiac tumors, cardiomyopathies, chronic heart failure, congenital heart disease, cor pulmonale, dilated cardiomyopathy, endomyocardial fibrosis, giant atrial myxoma, heart failure, hypertrophic cardiomyopathy, hurler syndrome, left ventricular failure (non-valvular), mitral stenosis, pacemaker syndrome, pericardial effusion, pericarditis, peripartum cardiomyopathy, peripheral edema, pulmonary embolism, Q fever myocarditis, restrictive cardiomyopathy, rheumatic heart disease, systemic hypertension
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Antidepressants, calcium channel blockers, diltiazem, nifedipine, trazodone
Ear Nose Throat No underlying causes
Endocrine Adrenal carcinoma, Cushing’s syndrome, thyroid disease
Environmental Pneumoconiosis
Gastroenterologic Gastroesophageal reflux disease, Hurler syndrome
Genetic Hurler syndrome
Hematologic Anemia, tropical pulmonary eosinophilia
Iatrogenic No underlying causes
Infectious Disease Chagas disease, Q fever myocarditis, Tropical pulmonary eosinophilia
Musculoskeletal/Orthopedic No underlying causes
Neurologic Myasthenia gravis, obstructive sleep apnea
Nutritional/Metabolic Hurler syndrome, metabolic acidosis, obesity
Obstetric/Gynecologic Pregnancy
Oncologic Adrenal carcinoma, paraneoplastic syndromes
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric Anxiety, Hurler syndrome, panic disorder
Pulmonary Cor pulmonale, emphysema, interstitial lung disease, pulmonary edema, pulmonary embolism, severe chronic obstructive pulmonary disease, tropical pulmonary eosinophilia
Renal/Electrolyte Renal failure
Rheumatology/Immunology/Allergy Myasthenia gravis, paraneoplastic syndromes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

Diagnosis

Diagnosis

Symptoms

The experience of PND is often described as awakening suddenly to a feeling that one is suffocating, with wheezing respirations and coughing. It can be quite frightening.

Treatment

Treatment

Treatment depends upon the underlying cause. The treatment of congestive heart failure can be found here.

Related Chapters
References

References

  1. ↑ 1.0 1.1 Yagishita-Tagawa Y, Yumino D, Takagi A, Serizawa N, Hagiwara N (2013). “Association between sleep apnea and overnight hemodynamic changes in hospitalized heart failure patients with and without paroxysmal nocturnal dyspnea”. J Cardiol. 61 (5): 348–53. doi:10.1016/j.jjcc.2012.12.010. PMID 23507270.
  2. ↑ Friedrich MG, Dill H, Unverdorben M, Engels G, Scheele H, Bachmann K (1994). “Adrenal carcinoma with intravenous extension into the tricuspid valvular plane in a patient with patent foramen ovale”. Eur Heart J. 15 (5): 708–9. PMID 8056015.
  3. ↑ Cassem N (1982). “Cardiovascular effects of antidepressants”. J Clin Psychiatry. 43 (11 Pt 2): 22–9. PMID 6816788.
  4. ↑ Lusiani L, Perrone A, Pesavento R, Conte G (1994). “Prevalence, clinical features, and acute course of atypical myocardial infarction”. Angiology. 45 (1): 49–55. PMID 8285384.
  5. ↑ Iglesias FJ, Wong A, Carrasco F, De Bernard C, Nuñez P (1994). “[Cardiac amyloidosis secondary to multiple myeloma detected by echocardiography]”. Rev Med Panama. 19 (3): 147–53. PMID 7746897.
  6. ↑ Wexler RK, Elton T, Pleister A, Feldman D (2009). “Cardiomyopathy: an overview”. Am Fam Physician. 79 (9): 778–84. PMC 2999879. PMID 20141097.
  7. ↑ Hayes D, Anstead MI, Ho J, Phillips BA (2009). “Insomnia and chronic heart failure”. Heart Fail Rev. 14 (3): 171–82. doi:10.1007/s10741-008-9102-1. PMID 18758945.
  8. ↑ Petramala L, Battisti P, Lauri G, Palleschi L, Cotesta D, Iorio M; et al. (2007). “Cushing’s syndrome patient who exhibited congestive heart failure”. J Endocrinol Invest. 30 (6): 525–8. PMID 17646730.
  9. ↑ 9.0 9.1 Meluzín J, Januska B (1990). “[Cardiac asthma after nifedipine and diltiazem]”. Cas Lek Cesk. 129 (50): 1590–2. PMID 2272077.
  10. ↑ Toda M, Motojima S, Fukuda T, Makino S (1991). “[Clinical and physiological features of chronic pulmonary emphysema with paroxysmal dyspnea attacks masquerading as bronchial asthma–improvement of respiratory function after combination therapy of intravenous aminophylline and subcutaneous epinephrine following daily oral administration of prednisolone]”. Nihon Kyobu Shikkan Gakkai Zasshi. 29 (4): 460–8. PMID 1865598.
  11. ↑ Mold JW, Reed LE, Davis AB, Allen ML, Decktor DL, Robinson M (1991). “Prevalence of gastroesophageal reflux in elderly patients in a primary care setting”. Am J Gastroenterol. 86 (8): 965–70. PMID 1858762.
  12. ↑ Vilela EP, Moura L, Pepe D, Nunes E, Erthal F, Campana E (2010). “Giant atrial myxoma mimicking severe mitral stenosis in young patient”. Arq Bras Cardiol. 95 (5): e125–7. PMID 21225110.
  13. ↑ Ekundayo OJ, Howard VJ, Safford MM, McClure LA, Arnett D, Allman RM; et al. (2009). “Value of orthopnea, paroxysmal nocturnal dyspnea, and medications in prospective population studies of incident heart failure”. Am J Cardiol. 104 (2): 259–64. doi:10.1016/j.amjcard.2009.03.025. PMC 2787196. PMID 19576357.
  14. ↑ Kraiem S, Lahidheb D, Chehaibi N, Sfaxi A, Terras M, Ben Ameur Y; et al. (2001). “[Mitral stenosis secondary to Hurler’s syndrome]”. Arch Mal Coeur Vaiss. 94 (2): 153–6. PMID 11265555.
  15. ↑ Nishimura Y, Maeda H, Hashimoto A, Tanaka K, Yokoyama M (1996). “Relationship between bronchial hyperreactivity and symptoms of cardiac asthma in patients with non-valvular left ventricular failure”. Jpn Circ J. 60 (12): 933–9. PMID 8996683.
  16. ↑ Horstkotte D (1992). “Arrhythmias in the natural history of mitral stenosis”. Acta Cardiol. 47 (2): 105–13. PMID 1615736.
  17. ↑ Schmidt-Nowara WW, Marder EJ, Feil PA (1984). “Respiratory failure in myasthenia gravis due to vocal cord paresis”. Arch Neurol. 41 (5): 567–8. PMID 6721725.
  18. ↑ Naughton MT (2006). “The link between obstructive sleep apnea and heart failure: underappreciated opportunity for treatment”. Curr Heart Fail Rep. 3 (4): 183–8. PMID 17129512.
  19. ↑ Minutiello L (1996). “[Paroxysmal nocturnal dyspnea as a severe expression of the pacemaker syndrome]”. Minerva Cardioangiol. 44 (3): 133–40. PMID 8767613.
  20. ↑ Leonard RB, Schwartz E, Allen DA, Alson RL (1992). “Peripartum cardiomyopathy: a case report”. J Emerg Med. 10 (2): 157–61. PMID 1607622.
  21. ↑ Rees PJ, Clark TJ (1979). “Paroxysmal nocturnal dyspnoea and periodic respiration”. Lancet. 2 (8156–8157): 1315–7. PMID 92669.
  22. ↑ Tartulier M, Boutarin J, Ritz B (1984). “Chronic pulmonary thromboembolism”. G Ital Cardiol. 14 Suppl 1: 13–21. PMID 6534760.
  23. ↑ Myers PO, Fassa AA, Panos A, Licker M, Bounameaux H, Zender HO; et al. (2008). “Life-threatening pulmonary embolism associated with a thrombus straddling a patent foramen ovale: report of a case”. J Card Surg. 23 (4): 376–8. doi:10.1111/j.1540-8191.2007.00542.x. PMID 18384574.
  24. ↑ Murcia J, Reus S, Climent V, Manso MI, López I, Tello A (2002). “[Acute myocardial failure in a young man: Q-fever myocarditis]”. Rev Esp Cardiol. 55 (8): 875–7. PMID 12199986.
  25. ↑ Aronow WS (1995). “The heart and thyroid disease”. Clin Geriatr Med. 11 (2): 219–29. PMID 7606691.
  26. ↑ Ong RK, Doyle RL (1998). “Tropical pulmonary eosinophilia”. Chest. 113 (6): 1673–9. PMID 9631810.


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]