People with this condition must keep their heads elevated to breathe comfortably. Some patients who experience paroxysmal nocturnal dyspnea also experience orthopnea: breathlessness when lying down that is relieved when several pillows raise the head and upper body. It's caused by congestion (excessive or abnormal accumulation of blood) in the lungs, perhaps along with accumulation of excess fluid in the lungs ( pulmonary edema), which occurs as a result of left-sided heart failure. Paroxysmal nocturnal dyspnea can be accompanied by swelling of the feet or ankles. While asthma is a chronic condition caused by inflammation of the airways, which can lead to breathing difficulties, paroxysmal nocturnal dyspnea is a sign of heart failure. This term is actually misleading - the two conditions are very different. Paroxysmal nocturnal dyspnoea takes at least 30 minutes to get some relief.ĭyspnea on exertion -> Dyspnea while lying down -> Paroxysmal nocturnal dyspnoea -> Dyspnea at rest -> Acute pulmonary edema.Paroxysmal nocturnal dyspnea is also sometimes called cardiac asthma because its signs and symptoms mimic those of asthma. Due to shortness of breath when lying down, it usually gets better very quickly after sitting up and hanging the legs on the ground. CONCLUDE:ĭyspnea while lying down and paroxysmal nocturnal dyspnoea are both more or less related to postural (lying) dyspnea, different from where the patient is awake or asleep. + Normal inhibition of respiratory center activity at night.–> aggravates pulmonary congestion and causes incompatibility between ventilation and perfusion => stimulates brain stem, increases respiration aspirate and wake the patient. + Increases parasympathetic activity, decreases alpha-adrenergic sympathetic activity => heart rate and contractility both decrease -> left ventricle loses its ability to resist the increase in blood volume into the ventricle. + Increased bronchial artery pressure => interstitial edema, decreased lung elasticity, increased airway resistance. Increase blood flow to the heart when lying down. Severe dyspnea that appears suddenly and intermittently at night while the patient is asleep forces them to wake up to breathe.įactors causing paroxysmal nocturnal dyspnea: Ascites, the large fetus pushes the diaphragm up.This symptom is not specific because it can be seen in situations that reduce vital capacity such as: When it progresses for a long time, causing right ventricular failure, pulmonary congestion decreases, so breathing difficulty will also decrease. – Mechanism: when lying down, there is a redistribution of body fluids: blood volume in the abdomen and legs decreases, blood to the lungs increases, but the left ventricle fails to eject blood in time –> left atrial pressure –> increased venous and capillary pressure pulmonary vessels. Half lying half sitting position, to the point of having to sit all night. – End: immediately after getting up, put your feet down on the bed. As it gets worse, shortness of breath can occur even at rest. Left ventricular function may be impaired by ischemia (temporarily or permanently due to decreased myocardial perfusion), previous myocardial infarction (damage), or hypertrophy (often associated with hypertension). It is the decrease in left ventricular cardiac output -> high left ventricular end-diastolic pressure -> increased pulmonary venous pressure -> drainage of fluid into the interstitial space and thus a decrease in pulmonary compliance. BREATHABLE WHEN EXERCISE:ĭue to inadequate left ventricular output during exertion. Shortness of breath when lying down (postural dyspnea). Patients with heart failure through history taking may present with the following dyspnea:
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