Question:
A patient with structural heart disease suddenly wakes up at night with dyspnoea and anxiety. What is your diagnosis?
A patient with structural heart disease suddenly wakes up at night with dyspnoea and anxiety. What is your diagnosis?
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Dyspnea Terminology:
- Orthopnea: Breathless lying flat (Heart failure).
- PND: Waking up breathless hours into sleep (Heart failure).
- Platypnea: Breathless sitting up (Hepatopulmonary syndrome).
- Trepopnea: Breathless lying on one side (Unilateral lung disease).
- Orthopnea: Breathless lying flat (Heart failure).
- PND: Waking up breathless hours into sleep (Heart failure).
- Platypnea: Breathless sitting up (Hepatopulmonary syndrome).
- Trepopnea: Breathless lying on one side (Unilateral lung disease).
Updated On: Sep 3, 2026
- Orthopnoea
- PND
- Platypnoea
- Trepopnoea
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The Correct Option is B
Solution and Explanation
Concept:
Different positional and temporal patterns of dyspnea provide critical clues to the underlying cardiopulmonary pathophysiology. The scenario describes a classic temporal presentation of left-sided heart failure.
Explanation:
• Paroxysmal Nocturnal Dyspnea (PND) (Option B) refers to attacks of severe shortness of breath and coughing that generally occur at night, waking the patient from sleep (typically 1 to 3 hours after going to bed).
• The pathophysiology of PND involves the gradual reabsorption of dependent edema from the lower extremities into the systemic circulation when the patient assumes a recumbent position. This increases venous return (preload) to the right heart. A failing left ventricle cannot handle this increased volume, leading to acute pulmonary venous congestion and interstitial edema, which abruptly awakens the patient with a feeling of suffocation and anxiety.
• Orthopnea (Option A) is dyspnea that occurs immediately upon lying flat and is relieved rapidly by sitting up. While related to PND, orthopnea does not typically have the delayed onset that wakes a patient from deep sleep.
• Platypnea (Option C) is dyspnea that worsens when sitting or standing upright and improves when lying flat. It is rare and often associated with right-to-left intracardiac shunts (like a PFO) or hepatopulmonary syndrome.
• Trepopnea (Option D) is dyspnea that occurs when lying on one specific side but not the other, often seen in unilateral lung disease (like a massive pleural effusion).
Final Answer:
Waking up suddenly from sleep with severe shortness of breath and anxiety due to delayed fluid redistribution is the definition of Paroxysmal Nocturnal Dyspnea (PND).
Different positional and temporal patterns of dyspnea provide critical clues to the underlying cardiopulmonary pathophysiology. The scenario describes a classic temporal presentation of left-sided heart failure.
Explanation:
• Paroxysmal Nocturnal Dyspnea (PND) (Option B) refers to attacks of severe shortness of breath and coughing that generally occur at night, waking the patient from sleep (typically 1 to 3 hours after going to bed).
• The pathophysiology of PND involves the gradual reabsorption of dependent edema from the lower extremities into the systemic circulation when the patient assumes a recumbent position. This increases venous return (preload) to the right heart. A failing left ventricle cannot handle this increased volume, leading to acute pulmonary venous congestion and interstitial edema, which abruptly awakens the patient with a feeling of suffocation and anxiety.
• Orthopnea (Option A) is dyspnea that occurs immediately upon lying flat and is relieved rapidly by sitting up. While related to PND, orthopnea does not typically have the delayed onset that wakes a patient from deep sleep.
• Platypnea (Option C) is dyspnea that worsens when sitting or standing upright and improves when lying flat. It is rare and often associated with right-to-left intracardiac shunts (like a PFO) or hepatopulmonary syndrome.
• Trepopnea (Option D) is dyspnea that occurs when lying on one specific side but not the other, often seen in unilateral lung disease (like a massive pleural effusion).
Final Answer:
Waking up suddenly from sleep with severe shortness of breath and anxiety due to delayed fluid redistribution is the definition of Paroxysmal Nocturnal Dyspnea (PND).
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