Paroxysmal nocturnal dyspnea

Paroxysmal Nocturnal Dyspnea

Paroxysmal nocturnal dyspnea (PND) is a medical condition characterized by sudden episodes of shortness of breath that occur during sleep. These episodes typically awaken the individual from sleep, causing significant distress and discomfort. PND is often associated with congestive heart failure and other conditions that affect the heart and lungs.

Pathophysiology

PND occurs due to the redistribution of fluid from the lower extremities to the lungs when a person is lying down. This fluid shift increases pulmonary venous pressure, leading to pulmonary congestion and edema. The resulting pulmonary congestion impairs gas exchange, causing the sensation of breathlessness.

During sleep, the body's autonomic nervous system is less active, which can exacerbate the symptoms of heart failure. The supine position also reduces the effectiveness of the diaphragm, further contributing to respiratory distress.

Clinical Presentation

Patients with PND typically report waking up suddenly with a feeling of suffocation or breathlessness. These episodes can last for several minutes and are often relieved by sitting up or standing, which helps to redistribute fluid away from the lungs.

Other symptoms that may accompany PND include:

• Orthopnea
• Cough
• Wheezing
• Palpitations

Diagnosis

The diagnosis of PND is primarily clinical, based on the patient's history and symptoms. However, further investigations may be necessary to determine the underlying cause. These may include:

• Echocardiography to assess cardiac function
• Chest X-ray to evaluate pulmonary congestion
• Electrocardiogram (ECG) to detect arrhythmias
• Pulmonary function tests

Management

The management of PND involves treating the underlying cause, most commonly heart failure. Treatment strategies may include:

• Diuretics to reduce fluid overload
• ACE inhibitors or angiotensin receptor blockers (ARBs) to improve cardiac function
• Beta-blockers to reduce cardiac workload
• Lifestyle modifications, such as reducing salt intake and elevating the head of the bed

Prognosis

The prognosis of PND depends on the underlying cause and the effectiveness of treatment. With appropriate management, symptoms can be controlled, and quality of life can be improved.

Also see

• Congestive heart failure
• Orthopnea
• Pulmonary edema
• Sleep apnea

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