Paroxysmal nocturnal dyspnea
Paroxysmal nocturnal dyspnea |
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
- Acute decompensated heart failure[1]
- Anxiety
- Aortic regurgitation
- Aortic stenosis
- Cardiomyopathies[2]
- Chronic heart failure[3]
- Congenital heart disease
- Cushing's syndrome[4]
- Dilated cardiomyopathy
- Heart failure[5]
- Emphysema
- Giant atrial myxoma[6]
- Mitral stenosis
- Obesity
- Obstructive sleep apnea[1][7]
- Severe chronic obstructive pulmonary disease
- Systemic hypertension
- Tropical pulmonary eosinophilia
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
- ↑ 1.0 1.1 Yagishita-Tagawa Y, Yumino D, Takagi A, Serizawa N, Hagiwara N (2013). "Association between sleep apnea and overnight hemodynamic changes in hospitalized heart failure patients with and without paroxysmal nocturnal dyspnea". J Cardiol. 61 (5): 348–53. doi:10.1016/j.jjcc.2012.12.010. PMID 23507270.
- ↑ Wexler RK, Elton T, Pleister A, Feldman D (2009). "Cardiomyopathy: an overview". Am Fam Physician. 79 (9): 778–84. PMC 2999879. PMID 20141097.
- ↑ 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.
- ↑ Petramala L, Battisti P, Lauri G, Palleschi L, Cotesta D, Iorio M; et al. (2007). "Cushing's syndrome patient who exhibited congestive heart failure". J Endocrinol Invest. 30 (6): 525–8. PMID 17646730.
- ↑ 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.
- ↑ Vilela EP, Moura L, Pepe D, Nunes E, Erthal F, Campana E (2010). "Giant atrial myxoma mimicking severe mitral stenosis in young patient". Arq Bras Cardiol. 95 (5): e125–7. PMID 21225110.
- ↑ 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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