Paroxysmal nocturnal dyspnea
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| Paroxysmal nocturnal dyspnea Classification and external resources | |
| ICD-10 | I50.1 |
|---|---|
| ICD-9 | 428.1 |
| MeSH | D004418 |
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Synonyms and related keywords: Cardiac asthma, PND
Paroxysmal nocturnal dyspnea is defined as sudden, severe shortness of breath at night that awakens a person from sleep, often with coughing and wheezing. It is most closely associated with congestive heart failure. PND commonly occurs several hours after a person with heart failure has fallen asleep. PND is often relieved by sitting upright, but not as quickly as simple orthopnea. Also unlike orthopnea, it does not develop immediately upon lying down.
PND is caused by increasing amounts of fluid entering the lung during sleep and filling the small, air-filled sacs (alveoli) in the lung responsible for absorbing oxygen from the atmosphere. This fluid typically rests in the legs (peripheral edema) during the day when the individual is upright. At night, when recumbent for an extended period, this fluid is reabsorbed, increasing total blood volume and blood pressure, leading to pulmonary hypertension in people with underlying left ventricular dysfunction. The pulmonary hypertension leads to the accumulation of fluid in the lungs, or pulmonary edema.
PND is a symptom of heart failure and other associated conditions such as mitral stenosis, aortic insufficiency, and systemic hypertension. It was first described by Charles Lepois in the 1500s.
The experience of PND is often described as awakening suddenly to a feeling that one is suffocating, with wheezing respirations and coughing. It can be quite frightening.[1]
Differential Diagnosis
Tropical pulmonary eosinophilia
See also
References
Symptoms and signs (R00-R69, 780-789) |
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| Circulatory and respiratory systems |
Tachycardia - Bradycardia - Palpitation - Heart murmur - Nosebleed - Hemoptysis - Cough - abnormalities of breathing (Dyspnea, Orthopnoea, Stridor, Wheeze, Cheyne-Stokes respiration, Hyperventilation, Mouth breathing, Hiccup, Bradypnea, Hypoventilation) - Chest pain - Asphyxia - Pleurisy - Respiratory arrest - Sputum - Bruit |
| Digestive system and abdomen | Abdominal pain - Acute abdomen - Nausea - Vomiting - Heartburn - Dysphagia - Flatulence - Burping - Fecal incontinence - Encopresis - Hepatomegaly - Splenomegaly - Hepatosplenomegaly - Jaundice - Ascites - Fecal occult blood - Halitosis |
| Skin and subcutaneous tissue | disturbances of skin sensation (Hypoesthesia, Paresthesia, Hyperesthesia) - Rash - Cyanosis - Pallor - Flushing - Petechia - Desquamation - Induration |
| Nervous and musculoskeletal systems |
abnormal involuntary movements (Tremor, Spasm, Fasciculation, Athetosis) - Gait abnormality - lack of coordination (Ataxia, Dysmetria, Dysdiadochokinesia, Hypotonia) - Tetany - Meningism - Hyperreflexia |
| Urinary system | Dysuria - Vesical tenesmus - Urinary incontinence - Urinary retention - Oliguria - Polyuria - Nocturia |
| Cognition, perception, emotional state and behaviour |
Anxiety - Somnolence - Coma - Amnesia (Anterograde amnesia, Retrograde amnesia) - Dizziness/Vertigo - smell and taste (Anosmia, Ageusia, Parosmia, Parageusia) |
| Speech and voice | speech disturbances (Dysphasia, Aphasia, Dysarthria) - symbolic dysfunctions (Dyslexia, Alexia, Agnosia, Apraxia, Acalculia, Agraphia) - voice disturbances (Dysphonia, Aphonia) |
| General symptoms and signs | Fever (Hyperpyrexia) - Headache - Chronic pain - Malaise - Fatigue - Fainting (Vasovagal syncope) - Febrile seizure - Shock (Cardiogenic shock) - Lymphadenopathy - Edema (Peripheral edema, Anasarca) - Hyperhidrosis (Sleep hyperhidrosis) - Delayed milestone - Failure to thrive - food and fluid intake (Anorexia, Polydipsia, Polyphagia) - Cachexia - Xerostomia - Clubbing |
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
