Paroxysmal nocturnal dyspnea: Difference between revisions

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*[[Aortic regurgitation]]
*[[Aortic regurgitation]]
*[[Aortic stenosis]]
*[[Aortic stenosis]]
*[[Cardiomyopathies]]
*[[Cardiomyopathies]]<ref name="pmid20141097">{{cite journal| author=Wexler RK, Elton T, Pleister A, Feldman D| title=Cardiomyopathy: an overview. | journal=Am Fam Physician | year= 2009 | volume= 79 | issue= 9 | pages= 778-84 | pmid=20141097 | doi= | pmc=PMC2999879 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20141097  }} </ref>
*[[Chronic heart failure]]
*[[Chronic heart failure]]<ref name="pmid18758945">{{cite journal| author=Hayes D, Anstead MI, Ho J, Phillips BA| title=Insomnia and chronic heart failure. | journal=Heart Fail Rev | year= 2009 | volume= 14 | issue= 3 | pages= 171-82 | pmid=18758945 | doi=10.1007/s10741-008-9102-1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18758945  }} </ref>
*[[Congenital heart disease]]
*[[Congenital heart disease]]
*[[Heart failure]]<ref name="pmid19576357">{{cite journal| author=Ekundayo OJ, Howard VJ, Safford MM, McClure LA, Arnett D, Allman RM et al.| title=Value of orthopnea, paroxysmal nocturnal dyspnea, and medications in prospective population studies of incident heart failure. | journal=Am J Cardiol | year= 2009 | volume= 104 | issue= 2 | pages= 259-64 | pmid=19576357 | doi=10.1016/j.amjcard.2009.03.025 | pmc=PMC2787196 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19576357  }} </ref>
*[[Emphysema]]
*[[Mitral stenosis]]
*[[Mitral stenosis]]
*[[Obesity]]
*[[Obesity]]
*[[Obstructive sleep apnea]]
*[[Obstructive sleep apnea]]<ref name="pmid17129512">{{cite journal| author=Naughton MT| title=The link between obstructive sleep apnea and heart failure: underappreciated opportunity for treatment. | journal=Curr Heart Fail Rep | year= 2006 | volume= 3 | issue= 4 | pages= 183-8 | pmid=17129512 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17129512  }} </ref>
*Severe [[COPD]] and [[emphysema]]
*[[chronic obstructive pulmonary disease|Severe Chronic obstructive pulmonary disease]]
*Tropical [[pulmonary eosinophilia]]
*[[pulmonary eosinophilia|Tropical pulmonary eosinophilia]]


==Diagnosis==
==Diagnosis==

Revision as of 17:09, 7 May 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Cardiac asthma; PND

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

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

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

Life Threatening Causes

Common Causes

Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

PND is a symptom of heart failure and other associated conditions such as mitral stenosis, aortic insufficiency, and systemic hypertension.

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

Related Chapters

References

  1. Wexler RK, Elton T, Pleister A, Feldman D (2009). "Cardiomyopathy: an overview". Am Fam Physician. 79 (9): 778–84. PMC 2999879. PMID 20141097.
  2. 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.
  3. 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.
  4. 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.

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