Table of ContentsView AllTable of ContentsSymptoms of Paroxysmal Nocturnal DyspneaCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms of Paroxysmal Nocturnal Dyspnea
Causes
Diagnosis
Treatment
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Contradiction of Terms?Some healthcare providers use the term PND to refer to nighttime breathlessness that can occur as a result of conditions likesleep apnea, while cardiologists often use the term only in reference to congestive heart failure.
Contradiction of Terms?
Some healthcare providers use the term PND to refer to nighttime breathlessness that can occur as a result of conditions likesleep apnea, while cardiologists often use the term only in reference to congestive heart failure.
People with PND experience classic nighttime episodes such as:
When someone who has been diagnosed with heart failure experiences PND, it is always an indication of substantially worsening heart failureand they should contact their healthcare provider right away or call 911, even if the symptoms resolve quickly.
Most cardiologists use the term “PND” specifically in reference to those experiencing breathlessness as a result of congestive heart failure. It most commonly occurs in people experiencing shortness of breath with exertion, or shortness of breath when lying down (orthopnea).
People who experience orthopnea usually have at least some swelling (edema) in their feet and legs, which, in heart failure, usually indicates fluid overload.
In people who have heart failure, lying down can cause significant fluid shifts in the body. Fluid tends to shift from the tissues into the plasma, which increases the plasma volume.
Strictly speaking, “paroxysmal nocturnal dyspnea” means “sudden-onset shortness of breath at night,” and as such it can be applied to any medical condition that may produce dyspnea during sleep.These include:
In PND, the heart’s left ventricle is suddenly unable to match the output of a more normally functioning right ventricle; this results in pulmonary congestion. Other reasons why it may occur include decreased responsiveness of the respiratory center in the brain and decreased adrenergic activity in the myocardium during sleep.
If you experience symptoms but have not been diagnosed with a heart condition, your healthcare provider is likely to order one of several tests to see the condition of the heart and measure heart function. These might include:
People with heart failure who develop PND may soon develop more severe, acute heart failure. They require aggressive therapy right away to prevent a severe, possibly life-threatening, episode of heart failure.
If the cause of PND is heart failure, it will require lifelong management through a combination of medications and lifestyle choices.Sometimes, surgery may be required to repair a heart valve or a device may be inserted which helps the heart to contract properly. With such treatments, heart failure can improve, and the heart sometimes becomes stronger.
A wide array of medications are given to treat heart failure, and therefore this condition. They include diuretics, anti-hypertensives, and cardiac medications, including beta blockers and ACE inhibitors:
Diuretics
Angiotensin-Converting Enzyme (ACE) Inhibitors
Angiotensin II Receptor Blockers (or Inhibitors)
Beta Blockers
Aldosterone Antagonists
Sodium-Glucose Cotransporter-2 (SGLT-2) Inhibitors
Hydralazine and isosorbide dinitrate (specifically benefits African-Americans with heart failure)
Angiotensin-Receptor Neprilysin Inhibitors (ARNIs)
Lifestyle Modifications
Surgery and Devices
Depending on the severity of your heart failure, surgery or a medical device may be necessary. Your healthcare provider may propose:
A Word From Verywell
It’s not up to you to figure out whether your acute dyspnea at night is due to heart failure or to some other cause. It’s up to your healthcare provider. What you need to know is that PNDalwaysindicates that a serious medical problem is going on. Whatever the cause turns out to be, you need to get medical help right away if you experience this symptom.
5 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.Heidenreich P, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure.J Am Coll Cardiol. 2022;79(17):e263–e421. doi:10.1016/j.jacc.2021.12.012Yagishita-Tagawa Y, Yumino D, Takagi A, Serizawa N, Hagiwara N.Association between sleep apnea and overnight hemodynamic changes in hospitalized heart failure patients with and without paroxysmal nocturnal dyspnea.Journal of Cardiology. 2013;61(5):348-353. doi:10.1016/j.jjcc.2012.12.010Mukerji V.Dyspnea, Orthopnea, and Paroxysmal Nocturnal Dyspnea. In: Walker HK, Hall WD, Hurst JW, eds.Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd Edition.Boston, MA: Butterworths; 1990.Fleg JL.Healthy lifestyle and risk of heart failure: An ounce of prevention well worth the effort.Circ Heart Fail. 2016;9(4):e003155. doi:10.1161/CIRCHEARTFAILURE.116.003155American Heart Association.Lifestyle changes for heart failure.
5 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.Heidenreich P, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure.J Am Coll Cardiol. 2022;79(17):e263–e421. doi:10.1016/j.jacc.2021.12.012Yagishita-Tagawa Y, Yumino D, Takagi A, Serizawa N, Hagiwara N.Association between sleep apnea and overnight hemodynamic changes in hospitalized heart failure patients with and without paroxysmal nocturnal dyspnea.Journal of Cardiology. 2013;61(5):348-353. doi:10.1016/j.jjcc.2012.12.010Mukerji V.Dyspnea, Orthopnea, and Paroxysmal Nocturnal Dyspnea. In: Walker HK, Hall WD, Hurst JW, eds.Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd Edition.Boston, MA: Butterworths; 1990.Fleg JL.Healthy lifestyle and risk of heart failure: An ounce of prevention well worth the effort.Circ Heart Fail. 2016;9(4):e003155. doi:10.1161/CIRCHEARTFAILURE.116.003155American Heart Association.Lifestyle changes for heart failure.
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.
Heidenreich P, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure.J Am Coll Cardiol. 2022;79(17):e263–e421. doi:10.1016/j.jacc.2021.12.012Yagishita-Tagawa Y, Yumino D, Takagi A, Serizawa N, Hagiwara N.Association between sleep apnea and overnight hemodynamic changes in hospitalized heart failure patients with and without paroxysmal nocturnal dyspnea.Journal of Cardiology. 2013;61(5):348-353. doi:10.1016/j.jjcc.2012.12.010Mukerji V.Dyspnea, Orthopnea, and Paroxysmal Nocturnal Dyspnea. In: Walker HK, Hall WD, Hurst JW, eds.Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd Edition.Boston, MA: Butterworths; 1990.Fleg JL.Healthy lifestyle and risk of heart failure: An ounce of prevention well worth the effort.Circ Heart Fail. 2016;9(4):e003155. doi:10.1161/CIRCHEARTFAILURE.116.003155American Heart Association.Lifestyle changes for heart failure.
Heidenreich P, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure.J Am Coll Cardiol. 2022;79(17):e263–e421. doi:10.1016/j.jacc.2021.12.012
Yagishita-Tagawa Y, Yumino D, Takagi A, Serizawa N, Hagiwara N.Association between sleep apnea and overnight hemodynamic changes in hospitalized heart failure patients with and without paroxysmal nocturnal dyspnea.Journal of Cardiology. 2013;61(5):348-353. doi:10.1016/j.jjcc.2012.12.010
Mukerji V.Dyspnea, Orthopnea, and Paroxysmal Nocturnal Dyspnea. In: Walker HK, Hall WD, Hurst JW, eds.Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd Edition.Boston, MA: Butterworths; 1990.
Fleg JL.Healthy lifestyle and risk of heart failure: An ounce of prevention well worth the effort.Circ Heart Fail. 2016;9(4):e003155. doi:10.1161/CIRCHEARTFAILURE.116.003155
American Heart Association.Lifestyle changes for heart failure.
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