Orthopnea: Orthopnea is the shortness of breath that happens while a person lying flat. The shortness of breath is followed by a tightness feeling in the chest and the feeling is as if he or she is not able to get enough oxygen for proper breathing. This occurs usually at night when a person is asleep. It is usually seen as a late demonstration of heart failure, causing an increase in pulmonary capillary pressure. It is likewise seen in cases of abdominal obesity or pulmonary disease. For this reason, anyone who experiences orthopnea should always be assessed by a physician.
Other shortness of breath include:
Trepopnea-This disorder makes shortness of breath when you lie on your side.
Platypnea-This disorder produces shortness of breath when you stand.
Orthopnea is due to the risen distribution of blood to the pulmonary circulation while lying, but usually can be associated with a more fundamental cause.
The shortness of breath due to Orthopnea is precipitated by the increased pressure in the veins which transport oxygen from the lungs to the heart. These veins bring oxygen-rich blood from the vein to the heart wherever the left ventricle pumps it within the aorta to be circulated throughout the body.
If the muscle fibres of the left ventricle become weak later the ventricle is not capable to pump in enough blood within the aorta for circulation to the rest of the body creating increased pressure in the veins bringing oxygenated blood to the left ventricle. This raised pressure thus begins shortness of breath as seen among Orthopnea.
Furthermore, during standing on the day the circulation of the blood is more towards the lower extremities due to gravitation but while an individual lies down to sleep this concentration of blood is increased towards the chest.
In a healthy person this change is not noticed as the muscle fibres of the left ventricle is powerful enough to pump out the blood from the area and retract its effect but in people with weak muscle fibres of the left ventricle the blood is not capable to be removed from the area, therefore, raising the pressure on the lungs and chest producing shortness of breath as felt in Orthopnea.
Due to this rise in pressure in the lungs, there may further be fluid buildup in the lungs beginning a condition called pulmonary oedema. Heart failure is the yet different complication that can develop as a result of Orthopnea.
Orthopnea is often also occurred in those with asthma and chronic bronchitis, as well as with sleep apnea or panic disorder. It is further linked to polycystic liver disease. From a neuromuscular panorama, orthopnea is a manifestation of severe diaphragmatic weakness.
The feature of Orthopnea is trouble breathing while lying down in any position. Additionally, there will be occasional tightness in the chest accompanied by shortness of breath. Though, there are also some other symptoms that can additionally accompany Orthopnea like swelling of the feet and ankles, persistent coughing.
Another symptom associated with heart failure is paroxysmal nocturnal dyspnea. Paroxysmal Nocturnal Dyspnea known as PND is also related to fluid redistribution that happens during sleep, but it is a more complex situation of orthopnea. Usually, people who have PND do not notice dyspnea right after lying down. Preferably, they are awakened from sleep with an experience of severe shortness of breath that makes them to immediately sit up for relief. In appreciation to dyspnea, patients with PND further often feel palpitations, severe wheezing, and a feeling of panic.
Clearly, paroxysmal nocturnal dyspnea is a far more tense event than orthopnea. It is believed that some additional mechanism (aside from simple fluid redistribution) is being in people with PND, possibly related to changes in the brain’s respiratory centre that may be correlated with heart failure.
Diagnosis is based often on the clinical features of Orthopnea. Doctors should routinely ask people with orthopnea whether they experience any dyspnea upon lying down.
This is important because worsening orthopnea usually indicates an underlying decline in cardiac function.
Many people with orthopnea deal with the symptom subconsciously by adding a pillow or two. This is why physicians will record the answers in the chart as “two-pillow orthopnea” or “three-pillow orthopnea.”
Early intervention while symptoms are comparatively mild can avoid a heart failure crisis, and anticipate the need for hospitalization.
To relieve shortness of breath, the physician will ask the patient to sleep in more of an upright position. This should help you breathe more easily.
This can be done by placing a couple of pillows beneath the head. Even the height of the head of the bed can be adjusted for this purpose.
If excess fluid is beginning breathing problems like orthopnea or paroxysmal nocturnal dyspnea, physicians may recommend a low-sodium diet, because too much sodium can add to fluid overload. They may also prescribe diuretics, medications that help the body excrete excess sodium and water. Nonetheless, diuretics sometimes become less effective over time, so following awhile, many people with fluid overload must be hospitalized for further treatment.
This approach can incorporate intravenous medications like loop diuretics, vasodilator drugs, and inotropic drugs ( cause the heart to pump more blood with each contraction).
If these approaches don’t work to decrease the fluid overload, physicians may prescribe a procedure known as ultrafiltration, in which blood is transferred through a small machine that filters excess fluid.