Differential diagnosis for orthopnea and paroxysmal nocturnal dyspnoea (PND)
Common and important causes of orthopnoea and paroxysmal nocturnal dyspnoea (PND) for doctors and medical students
|Pulmonary oedema due to congestive (chronic) left ventricular failure||Suggested by: dyspnoea, displaced apex beat, third heart sound, bilateral basal fine crackles.
Confirmed by: CXR appearances. Impaired left ventricular (LV) function on echocardiogram. Abnormal ECG reflecting underlying heart disease
|COPD||Suggested by: smoking history, cough and sputum. Pursed lip breathing, use of accessory muscles, reduced breath sounds, wheezes. Chest hyperinflation. Reduced peak flow rate.
Confirmed by: CXR: radiolucent lungs. Spirometry: reduced FEV, reduced FEV1/FVC ratio, <12% reversibility, hypoxia ± increased arterial PCO (rarely, reduced α 1-antitrypsin levels).
|Asthma||Suggested by: wheeze or dry cough. Other specific triggers to breathlessness. Other allergies. Past history of similar attacks unless first presentation.
Confirmed by: reversibility following bronchodilator treatment, and symptomatic response to treatment.