Ortopnoe

Ortopnoe, also spelled orthopnea or orthopnoea, is a type of dyspnea that occurs or worsens when a person lies flat and is relieved by sitting up or standing. It is most commonly linked to left-sided heart failure but can arise from other cardiopulmonary conditions that impair the heart’s ability to manage venous return or reduce lung compliance.

Pathophysiology and causes: when lying down, venous return to the heart increases, raising left atrial and pulmonary venous pressures. This can promote pulmonary edema and reduce lung volumes, especially at the bases, making breathing more difficult. Conditions associated with orthopnea include chronic heart failure with reduced or preserved ejection fraction, mitral valve disease, restrictive cardiomyopathy, acute coronary syndromes with LV dysfunction, obesity, and severe sleep-disordered breathing.

Clinical features and assessment: patients often report breathlessness that forces them to sleep propped up on pillows or in a semi-upright position. Paroxysmal nocturnal dyspnea may accompany orthopnea. On examination, signs of heart failure such as raised jugular venous pressure, crackles in the lungs, peripheral edema, or an S3/S4 may be present. The degree of orthopnea is sometimes described by the number of pillows required to achieve relief.

Diagnosis and evaluation: diagnosis is guided by history and exam and is supported by tests for underlying heart disease. Investigations may include echocardiography to assess cardiac function, chest radiography, B-type natriuretic peptide (BNP) levels, electrocardiography, and other studies as indicated.

Management: treatment targets the underlying cause, most commonly heart failure. Diuretics reduce preload, while other therapies optimize cardiac function and hemodynamics. Nonpharmacologic measures include elevating the head of the bed and avoiding excessive fluid or salt intake. Prognosis depends on the underlying condition and response to therapy.