Orthopnea - Causes and Symptoms

Definition

Orthopnea (or dyspnea from decubitus) consists of a respiratory difficulty that occurs when the patient is lying on his back; this forces the patient to sleep sitting or semi-sitting with additional cushions (the sitting position with dangling legs gives immediate relief). The patient suffering from orthopnea wakes up with a start, presenting a rapid and superficial breath, often interrupted by coughing. Due to the lack of oxygen, symptoms such as pallor and cyanosis, agitation and fear appear.

Orthopnea occurs particularly at night and at rest; it is therefore not related to physical exercise, although dyspnea on exertion (difficulty breathing in conjunction with physical exertion) often precedes the appearance of orthopnea in patients with heart failure.

Orthopnea is a characteristic symptom of left ventricular failure, as the lying position imposes more work on the heart to pump the increased amount of blood circulating in the thoracic area due to gravitational reasons. Furthermore, left heart failure is typically associated with pulmonary edema, ie the accumulation of fluid in the lungs; again due to gravitational issues, when the subject is lying on a flat surface, all the lung poisons are invaded by plasma and this causes breathing difficulties. In fact, the increased blood pressure that stagnates in the lungs causes an increase in pressure in the alveolar capillaries with leakage of fluids, worsening of the edema and reactive bronchospasm (cardiac asthma).

More rarely, orthopnea is observed in conjunction with some lung diseases, such as chronic obstructive bronchopathies (pulmonary emphysema, chronic bronchitis, etc.) or an asthma crisis. It is also present in patients affected by ascites, diaphragmatic dysfunctions or panic attacks.