Shortness of breath while lying down and paroxysmal nocturnal dyspnea

BREATHABLE WHEN WHICH WEIGHT AND PARTICULAR DISEASE OF Breathlessness at Night

What is Paroxysmal Nocturnal Dyspnoea?

Patients with heart failure through history taking may present with the following dyspnea:

– Shortness of breath on exertion.

Shortness of breath when lying down (postural dyspnea).

– Paroxysmal nocturnal dyspnea.

I. BREATHABLE WHEN EXERCISE:

Due to inadequate left ventricular output during exertion. It is the decrease in left ventricular cardiac output -> high left ventricular end-diastolic pressure -> increased pulmonary venous pressure -> drainage of fluid into the interstitial space and thus a decrease in pulmonary compliance. Left ventricular function may be impaired by ischemia (temporarily or permanently due to decreased myocardial perfusion), previous myocardial infarction (damage), or hypertrophy (often associated with hypertension). . As it gets worse, shortness of breath can occur even at rest.

II. HARD TO Breathe While Holding:

– Appearance: after lying down.

– End: immediately after getting up, put your feet down on the bed. Half lying half sitting position, to the point of having to sit all night.

– Mechanism: when lying down, there is a redistribution of body fluids: blood volume in the abdomen and legs decreases, blood to the lungs increases, but the left ventricle fails to eject blood in time –> left atrial pressure –> increased venous and capillary pressure pulmonary vessels. When it progresses for a long time, causing right ventricular failure, pulmonary congestion decreases, so breathing difficulty will also decrease. This symptom is not specific because it can be seen in situations that reduce vital capacity such as:

+ Heart failure.

Other rare causes:

  • Ascites, the large fetus pushes the diaphragm up.
  • Bilateral diaphragmatic paralysis.
  • A lot of pleural effusion.
  • Severe pneumonia.
  Ramsay Hunt Syndrome (Ramsay Hunt Syndrome)

VIII. HARD TO Breathe DREAM PLAY IN THE NIGHT

Severe dyspnea that appears suddenly and intermittently at night while the patient is asleep forces them to wake up to breathe.

Factors causing paroxysmal nocturnal dyspnea:

Increase blood flow to the heart when lying down.

+ Increased bronchial artery pressure => interstitial edema, decreased lung elasticity, increased airway resistance.

+ Increases parasympathetic activity, decreases alpha-adrenergic sympathetic activity => heart rate and contractility both decrease -> left ventricle loses its ability to resist the increase in blood volume into the ventricle.

+ Normal inhibition of respiratory center activity at night.–> aggravates pulmonary congestion and causes incompatibility between ventilation and perfusion => stimulates brain stem, increases respiration aspirate and wake the patient.

CONCLUDE:

Dyspnea while lying down and paroxysmal nocturnal dyspnoea are both more or less related to postural (lying) dyspnea, different from where the patient is awake or asleep. Due to shortness of breath when lying down, it usually gets better very quickly after sitting up and hanging the legs on the ground. Paroxysmal nocturnal dyspnoea takes at least 30 minutes to get some relief.

Severity of breathlessness:

Dyspnea on exertion -> Dyspnea while lying down -> Paroxysmal nocturnal dyspnoea -> Dyspnea at rest -> Acute pulmonary edema.

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