Orthopnea: Causes, Symptoms, Treatment

Orthopnea is a pathological condition of the respiratory system characterized by shortness of breath or difficulty breathing when in a lying down position. This happens usually at night when an individual is asleep. The shortness of breath is accompanied by a tightness feeling in the chest and the feeling is as if he or is not able to take in enough oxygen for proper breathing.

Any position when lying down whether supine, prone, or recumbent can cause shortness of breath in an individual with Orthopnea. This condition in itself may not be too serious but it definitely points to various potential serious medical illnesses that the affected individual might be having.

Thus, it is highly recommended that any individual with symptoms of shortness of breath even when lying down should get a detailed clinical evaluation done to rule out any potential serious underlying medical illnesses.

The main reason as to why an individual gets orthopnea or short of breath when lying down is because of increased pressure in the veins that connect heart to the lungs resulting in higher pressure around the lungs which makes it difficult for the lungs to function resulting in shortness of breath. Edema of the lower extremities and intermittent chest pains are also some of the symptoms associated with Orthopnea.

Orthopnea is usually seen more in people who are overweight and thus such individuals need to be more aware of the symptoms and closely monitor any signs or symptoms of Orthopnea. Additionally, pregnant females are also equally at risk for developing Orthopnea and are recommended to keep a close eye on any symptoms which may suggest Orthopnea.

As stated, the shortness of breath due to Orthopnea is caused by the increase in pressure in the veins which carry oxygen from the lungs to the heart. These veins carry oxygen rich blood from the vein to the heart where the left ventricle pumps it into the aorta to be distributed throughout the body.

If the muscles of the left ventricle become weak then the ventricle is not able to pump in enough blood into the aorta for distribution to the rest of the body causing an increased pressure in the veins carrying oxygenated blood to the left ventricle. This increased pressure thus causes shortness of breath as seen with Orthopnea.

Also, during standing in the day the distribution of the blood is more towards the lower extremities due to gravity but when an individual lies down to sleep this concentration of blood is more towards the chest.

In a normal healthy individual this change in not noticed as the muscles of the left ventricle is strong enough to pump out the blood from the area and negate its effect but in people with weak muscles of the left ventricle the blood is not able to be removed from the area thus increasing the pressure on the lungs and chest causing shortness of breath as experienced in Orthopnea.

Due to this increase in pressure in the lungs there may also be fluid accumulation in the lungs causing a condition called as pulmonary edema. Heart failure is yet another complication that can appear as a result of Orthopnea.

The classic presenting feature of Orthopnea is difficulty breathing when lying down in any position. Additionally, there will be intermittent tightness in the chest along with shortness of breath. However, there are also certain other signs and symptoms that can also accompany Orthopnea like pedal edema or swelling of the feet and ankles, intermittent chest pains, persistent coughing.

Another condition which is quite often associated with Orthopnea is Paroxysmal Nocturnal Dyspnea. In this condition, the affected individual may wake up suddenly from sleep due to severe shortness of breath which quickly abates when the individual stands up from a lying down position.

There are quite a few medical treatments available to treat Orthopnea. To begin with, the physician will ask the patient to sleep in more of an upright position. This can be done by placing a couple of pillows beneath the head. Even the height of the head of the bed can be adjusted for this purpose.

This has been shown to be extremely effective in treating symptoms of Orthopnea even though it does not treat the underlying condition. For fluid accumulation, diuretics may be prescribed in order to get rid of excess fluid. The physician may also recommend a reduction in sodium intake to decrease fluid accumulation.

The physician may also give medications to strengthen the heart muscles so that they are able to pump more blood out of the left ventricle and decrease the pressure on the veins which ultimately treats Orthopnea.

Vasodilators are also quite helpful as they increase the width of the veins and allow the blood to flow more freely and reducing the pressure on the veins thereby treating Orthopnea.