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== Orthopnea ==
{{Short description|Difficulty breathing when lying flat}}
{{Use dmy dates|date=October 2023}}


[[File:Heartfailure.jpg|thumb|500px|Heartfailure]]
'''Orthopnea''' is a medical condition characterized by [[dyspnea]], or difficulty breathing, that occurs when a person is lying flat. This condition is often relieved by sitting or standing up. Orthopnea is commonly associated with [[heart failure]], but it can also be seen in other conditions such as [[obesity]], [[asthma]], and [[chronic obstructive pulmonary disease]] (COPD).


==Pathophysiology==
Orthopnea occurs due to the redistribution of body fluids when a person lies down. In a supine position, blood from the lower extremities is redistributed to the central circulation, increasing the volume of blood returning to the heart. In individuals with compromised cardiac function, such as those with heart failure, the heart may not be able to handle this increased preload, leading to pulmonary congestion and difficulty breathing.


'''Orthopnea''' is [[shortness of breath]] (dyspnea) that occurs when [[supine position|lying flat]],<ref>{{DorlandsDict|six/000075971|orthopnea}}</ref> causing the person to have to sleep propped up in bed or sitting in a chair. It is commonly seen as a late manifestation of [[heart failure]], resulting from [[edema|fluid]] redistribution into the central circulation, causing an increase in pulmonary capillary pressure. It is also seen in cases of [[abdominal obesity]] or pulmonary disease.<ref>Anthony Fauci, Eugene Braunwald, Dennis Kasper, Stephen Hauser, Dan Longo, J. Jameson, Joseph Loscalzo, (2008). ''[[Harrison's Principles of Internal Medicine]]'', 17th ed. [[McGraw-Hill]]. {{ISBN|9780071466332}}. p.1446</ref> Orthopnea is the opposite of [[platypnea]], shortness of breath that worsens when sitting or standing up.
==Causes==
Orthopnea is most commonly associated with:


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* '''[[Heart failure]]''': In heart failure, the heart's ability to pump blood is impaired, leading to fluid accumulation in the lungs when lying flat.
title='''{{PAGENAME}}'''  
* '''[[Obesity]]''': Excess body weight can restrict lung expansion and diaphragm movement, exacerbating breathing difficulties when supine.
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* '''[[Chronic obstructive pulmonary disease|COPD]]''': Patients with COPD may experience orthopnea due to increased airway resistance and reduced lung volumes.
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* '''[[Asthma]]''': Asthma can cause orthopnea due to airway inflammation and bronchoconstriction.
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==Causes==
==Symptoms==
Orthopnea is often a symptom of [[Left ventricle|left ventricular]] [[heart failure]] and/or [[pulmonary edema]].<ref name="pmid16899847">{{cite journal |vauthors=Torchio R, Gulotta C, Greco-Lucchina P, etal |title=Orthopnea and tidal expiratory flow limitation in chronic heart failure |journal=Chest |volume=130 |issue=2 |pages=472–9 |date=August 2006 |pmid=16899847 |doi=10.1378/chest.130.2.472 |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=16899847}}</ref><ref name=Mukerji>{{cite book |chapter-url=https://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cm&part=A454 |chapter=Dyspnea, Orthopnea, and Paroxysmal Nocturnal Dyspnea |first=bVaskar |last=Mukerji |title=Clinical Methods: The; History, Physical, and Laboratory Examinations |edition=3rd |editor1-last=Walker |editor1-first=H. Kenneth |editor2-last=Hall |editor2-first=W. Dallas |editor3-last=Hurst |editor3-first=J. Willis |isbn= 0-407-02853-6 |publisher=Butterworths |year=1990 |accessdate=2009-03-14}}</ref> It can also occur in those with [[asthma]] and chronic [[bronchitis]], as well as those with [[sleep apnea]] or [[panic disorder]].{{Citation needed|date=January 2009}}  It is also associated with [[polycystic liver disease]].<ref>{{cite web |last1=Kerns |first1=Marcia A. |title=Causes for Orthopnea |url=http://www.findatopdoc.com/Healthy-Living/what-is-orthopnea |website=Findatopdoc |publisher=H. Dix |accessdate=27 January 2009}}</ref> From a neuromuscular perspective, orthopnea is a sign of severe diaphragmatic weakness. Under such circumstances, patients may describe shortness of breath when they bend over (e.g. when tying shoelaces)..
The primary symptom of orthopnea is difficulty breathing when lying flat. Patients may report needing to sleep propped up on pillows or in a chair to alleviate symptoms. Other associated symptoms can include:


==Mechanism==
* [[Cough]]
Orthopnea is due to increased distribution of blood to the [[pulmonary circulation]] when a person lies flat or closer to a horizontal position. Lying flat decreases the inhibitory effect that the gravity usually has on the blood that is coming back to the heart from the lower extremities of the body. This increases the right sided venous return. In a normal person, this redistribution of blood has little effect on respiratory function as the left ventricle has the adequate capacity to suddenly increase its stroke volume (as a result of Frank-Starling mechanism). In a person with [[heart failure]], the left ventricle has an inadequate capacity to respond to increased arrival of blood from the pulmonary circulation. This leads to the pooling up of blood in the pulmonary circulation. The increased intra-parenchymal pulmonary intravascular pressure can also result in hydrostatic pressure related fluid exudation into the [[Pulmonary alveolus|alveoli]], thus causing [[pulmonary edema]] and further worsening shortness of breath. Thus, shortness of breath is commonly experienced after a reasonably short time lying near to flat for a person with left ventricular failure.<ref name=Mukerji/> This is different from the dyspnea experienced by someone with lung parenchymal pathology (both restrictive and obstructive) when lying down, which is sudden and instead related to an acute change in diaphragmatic/accessory respiratory muscle mechanical advantage lost when moving the body into a more horizontal position.
* [[Wheezing]]
* [[Paroxysmal nocturnal dyspnea]]
* [[Fatigue]]


==Diagnosis==
==Diagnosis==
Diagnosis is based mostly on the clinical features.
Diagnosis of orthopnea is primarily clinical, based on the patient's history and symptoms. A thorough [[physical examination]] and [[medical history]] are essential. Additional diagnostic tests may include:
 
==Treatment==
 
Treating the underlying cause will serve the purpose.


==Etymology ==
* [[Chest X-ray]]: To assess for pulmonary congestion or other abnormalities.
The word ''orthopnea'' uses [[classical compound|combining forms]] of ''[[wikt:ortho-#Prefix|ortho-]]'' + ''[[wikt:-pnea#Suffix|-pnea]]'', from [[Greek language|Greek]] ''ortho'', straight, regular, + ''pnoia'', breath. [[Shortness of breath#Collation of -pnea transcriptions|See pronunciation information at ''dyspnea''.]]
* [[Echocardiogram]]: To evaluate cardiac function and structure.
* [[Pulmonary function tests]]: To assess lung function and identify obstructive or restrictive patterns.


==See also==
==Management==
* [[Paroxysmal nocturnal dyspnoea]]
Management of orthopnea involves treating the underlying cause. General measures include:
* [[Trepopnea]]


==References==
* '''Positioning''': Encouraging patients to sleep with the head elevated or in a sitting position.
{{Reflist}}
* '''Medications''': Diuretics, [[beta-blockers]], and [[ACE inhibitors]] for heart failure; bronchodilators and corticosteroids for asthma and COPD.
* '''Lifestyle modifications''': Weight loss in obese patients, smoking cessation, and avoiding allergens or irritants.


== External links ==
==Prognosis==
{{Medical resources
The prognosis of orthopnea depends on the underlying cause and the effectiveness of treatment. In heart failure, effective management can significantly improve symptoms and quality of life. In chronic respiratory conditions, controlling inflammation and airway obstruction is key to reducing symptoms.
|  DiseasesDB    =
|  ICD10          = {{ICD10|R|06|0|r|00}}
|  ICD9          = {{ICD9|786.02}}
|  ICDO          =
|  OMIM          =
|  MedlinePlus    =
|  eMedicineSubj  =
|  eMedicineTopic =
}}
{{Circulatory and respiratory system symptoms and signs}}


[[Category:Breathing abnormalities ]]
==Related pages==
* [[Dyspnea]]
* [[Paroxysmal nocturnal dyspnea]]
* [[Heart failure]]
* [[Chronic obstructive pulmonary disease]]


{{stub}}
[[Category:Respiratory diseases]]
{{respiratory-disease-stub}}
[[Category:Symptoms and signs: Respiratory system]]

Revision as of 19:07, 22 March 2025

Difficulty breathing when lying flat



Orthopnea is a medical condition characterized by dyspnea, or difficulty breathing, that occurs when a person is lying flat. This condition is often relieved by sitting or standing up. Orthopnea is commonly associated with heart failure, but it can also be seen in other conditions such as obesity, asthma, and chronic obstructive pulmonary disease (COPD).

Pathophysiology

Orthopnea occurs due to the redistribution of body fluids when a person lies down. In a supine position, blood from the lower extremities is redistributed to the central circulation, increasing the volume of blood returning to the heart. In individuals with compromised cardiac function, such as those with heart failure, the heart may not be able to handle this increased preload, leading to pulmonary congestion and difficulty breathing.

Causes

Orthopnea is most commonly associated with:

  • Heart failure: In heart failure, the heart's ability to pump blood is impaired, leading to fluid accumulation in the lungs when lying flat.
  • Obesity: Excess body weight can restrict lung expansion and diaphragm movement, exacerbating breathing difficulties when supine.
  • COPD: Patients with COPD may experience orthopnea due to increased airway resistance and reduced lung volumes.
  • Asthma: Asthma can cause orthopnea due to airway inflammation and bronchoconstriction.

Symptoms

The primary symptom of orthopnea is difficulty breathing when lying flat. Patients may report needing to sleep propped up on pillows or in a chair to alleviate symptoms. Other associated symptoms can include:

Diagnosis

Diagnosis of orthopnea is primarily clinical, based on the patient's history and symptoms. A thorough physical examination and medical history are essential. Additional diagnostic tests may include:

Management

Management of orthopnea involves treating the underlying cause. General measures include:

  • Positioning: Encouraging patients to sleep with the head elevated or in a sitting position.
  • Medications: Diuretics, beta-blockers, and ACE inhibitors for heart failure; bronchodilators and corticosteroids for asthma and COPD.
  • Lifestyle modifications: Weight loss in obese patients, smoking cessation, and avoiding allergens or irritants.

Prognosis

The prognosis of orthopnea depends on the underlying cause and the effectiveness of treatment. In heart failure, effective management can significantly improve symptoms and quality of life. In chronic respiratory conditions, controlling inflammation and airway obstruction is key to reducing symptoms.

Related pages

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