Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
In this article, learn the causes and symptoms of orthopnea along with its diagnosis and treatment.
Verywell / Laura Porter
Symptoms of Orthopnea
When experiencing orthopnea, the dyspnea usually occurs within a minute or so of lying down. Similarly, if the person sits up or elevates his or her head, the shortness of breath typically resolves quickly. So, for a person with this symptom, there is little doubt that it is related to a change in position.
People with orthopnea usually prop themselves up to sleep. Sometimes, an extra pillow or two is all it takes to relieve the symptoms; others may find they must sleep sitting in a chair.
Related Symptoms
A symptom similar to orthopnea, and one that is also strongly associated with heart failure, isparoxysmal nocturnal dyspneaorPND. Like orthopnea, PND is a type of shortness of breath that occurs in relation to sleep. Both orthopnea and PND are related to fluid redistribution within the body during sleep, but PND is a more complex condition than “simple” orthopnea.
Generally, people who have PND do not notice dyspnea right after lying down. Instead, they are awakened later on, usually from a sound sleep, with an episode of severe dyspnea that causes them to sit or stand up for relief immediately. In addition to dyspnea, patients with PND also often experiencepalpitations, severe wheezing, coughing, and a sense of panic.
PND is a far more dramatic event than orthopnea. It is thought that some additional mechanism (aside from simple fluid redistribution) is taking place in people with PND, most likely related to changes in the brain’s respiratory center that may be associated with heart failure.
What Is the Main Cause of Orthopnea?
When anyone lies down flat, gravity causes a redistribution of fluid within the body. Typically, lying down causes some of the fluid in the lower part of the body, particularly the legs and the organs of the abdomen, to gravitate into the chest area. This redistribution of fluid is usually quite minor, and in most people, it does not affect breathing at all.
However, people withcongestive heart failurehave a substantial amount of excess fluid in their bodies, and when this additional fluid is redistributed, the weakened heart may be unable to perform the additional work necessary to keep it from accumulating in the lungs. As a result, pulmonary congestion—and earlypulmonary edema—may occur, and shortness of breath results.
Sleep apneacan also produce symptoms similar to orthopnea or, more often, to PND.
Orthopnea has also been reported as a symptom in people who have paralysis of one or both diaphragm muscles (breathing muscles).
Orthopnea has also been seen in people with largegoiters(thyroid gland enlargement), which can obstruct airflow in the upper airways when lying down.
Diagnosing Orthopnea
In most cases, making the diagnosis of orthopnea is pretty straightforward. Healthcare providers ask patients about nocturnal dyspnea and whether they can sleep while lying flat as part of a routine medical evaluation.
If a person describes orthopnea to a practitioner, the healthcare provider will ask follow-up questions to pinpoint the cause. For instance, symptoms consistent with heart failure, sleep apnea, asthma, or bronchitis should be elicited. A thorough physical examination to uncover the physical signs of these kinds of medical problems will also help to determine the cause.
Additional testing is often needed to diagnose the cause of orthopnea. Anechocardiogram,pulmonary function tests, orsleep studiesare commonly obtained. In most cases, the cause of the orthopnea will become apparent after a complete medical history, physical examination, and a non-invasive test or two.
Because worsening orthopnea is often an early sign of worsening heart failure, anyone with heart failure (and their significant others) should pay attention to this symptom and even to the number of pillows they are using. Early intervention, when symptoms are relatively mild, can avoid a heart failure crisis and prevent the need for hospitalization.
Treatment of Orthopnea
An important goal in treating a person with heart failure is to eliminate orthopnea. Most cardiologists will consider lingering orthopnea to be a sign that a person’s heart failure may be inadequately treated and is usually considered a reason to be more aggressive with therapy.
Treating orthopnea requires identifying and treating the underlying cause. In most cases, orthopnea is due to heart failure, and (as noted) an essential goal intreating heart failureshould be to eliminate orthopnea.
Summary
Orthopnea is usually a manifestation of pulmonary congestion that can occur in people with heart failure or other medical conditions. The onset of orthopnea or changes in its severity can indicate essential changes in the severity of heart failure. Other significant medical conditions can also cause orthopnea, so this symptom should always be reported to your healthcare provider.
2 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Lee JH, Kim MS, Kim EJ, et al.Kshf guidelines for the management of acute heart failure: part i. Definition, epidemiology and diagnosis of acute heart failure.Korean Circ J. 2018;49(1):1-21. doi:10.4070/kcj.2018.0373Rostamzadeh A, Khademvatani K, Salehi S, et al.Echocardiographic parameters associated with bendopnea in patients with systolic heart failure.J Tehran Heart Cent. 2022;17(4):223-229. doi:10.18502/jthc.v17i4.11611Additional ReadingGanong WF. Respiratory Adjustments in Health and Disease. In: Review of Medical Physiology, 12th ed. Los Altos: Lange Medical Publications, 1985;558–71.Thibodeau JT, Turer AT, Gualano SK, et al. Characterization of a Novel Symptom of Advanced Heart Failure: Bendopnea. JACC Heart Fail 2014; 2:24–31.Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure: Executive Summary: a Report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013; 128:1810.
2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Lee JH, Kim MS, Kim EJ, et al.Kshf guidelines for the management of acute heart failure: part i. Definition, epidemiology and diagnosis of acute heart failure.Korean Circ J. 2018;49(1):1-21. doi:10.4070/kcj.2018.0373Rostamzadeh A, Khademvatani K, Salehi S, et al.Echocardiographic parameters associated with bendopnea in patients with systolic heart failure.J Tehran Heart Cent. 2022;17(4):223-229. doi:10.18502/jthc.v17i4.11611Additional ReadingGanong WF. Respiratory Adjustments in Health and Disease. In: Review of Medical Physiology, 12th ed. Los Altos: Lange Medical Publications, 1985;558–71.Thibodeau JT, Turer AT, Gualano SK, et al. Characterization of a Novel Symptom of Advanced Heart Failure: Bendopnea. JACC Heart Fail 2014; 2:24–31.Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure: Executive Summary: a Report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013; 128:1810.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Lee JH, Kim MS, Kim EJ, et al.Kshf guidelines for the management of acute heart failure: part i. Definition, epidemiology and diagnosis of acute heart failure.Korean Circ J. 2018;49(1):1-21. doi:10.4070/kcj.2018.0373Rostamzadeh A, Khademvatani K, Salehi S, et al.Echocardiographic parameters associated with bendopnea in patients with systolic heart failure.J Tehran Heart Cent. 2022;17(4):223-229. doi:10.18502/jthc.v17i4.11611
Lee JH, Kim MS, Kim EJ, et al.Kshf guidelines for the management of acute heart failure: part i. Definition, epidemiology and diagnosis of acute heart failure.Korean Circ J. 2018;49(1):1-21. doi:10.4070/kcj.2018.0373
Rostamzadeh A, Khademvatani K, Salehi S, et al.Echocardiographic parameters associated with bendopnea in patients with systolic heart failure.J Tehran Heart Cent. 2022;17(4):223-229. doi:10.18502/jthc.v17i4.11611
Ganong WF. Respiratory Adjustments in Health and Disease. In: Review of Medical Physiology, 12th ed. Los Altos: Lange Medical Publications, 1985;558–71.Thibodeau JT, Turer AT, Gualano SK, et al. Characterization of a Novel Symptom of Advanced Heart Failure: Bendopnea. JACC Heart Fail 2014; 2:24–31.Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure: Executive Summary: a Report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013; 128:1810.
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