Description, Causes and Risk Factors:

Orthopnea is shortness of breath that is triggered by lying flat. When orthopnea becomes severe the person will often prop themselves up with two or more pillows to make breathing easier. Orthopnea is a common symptom of heart or lung disease. One of the most common causes of orthopnea is congestive heart failure.

Most patients who experience orthopnea wake up short of breath during the night. Some patients experience shortness of breath so acutely they need to sleep propped up in a sitting position rather than lying in bed to keep their head elevated in order to breathe deeply. Orthopnea can be caused by heart, lung and sleep apnea problems.


Pediatric Orthopnea: This condition occurs in infants to children below 12 years old. Same reason - children are having a hard time breathing due to the improper lying down position.

  • Orthopnea during pregnancy: Common cause of having Orthopnea on pregnant women are the following: congestive cardiac failure, intravenous fluid overload, myocardial infarction, peripartum cardiomyopathy, and severe anemia.

The two is just some of the most common types of orthopnea. But in reality, there is still more to it.

Orthopnea is caused by pulmonary congestion during recumbency. In the horizontal position, there is a redistribution of blood volume from the lower extremities and splanchnic beds to the lungs. In normal individuals, this has little effect, but in patients in whom the additional volume cannot be pumped out by the left ventricle because of disease, there is a significant reduction in vital capacity and pulmonary compliance with resultant shortness of breath. Additionally, in patients with congestive heart failure, the pulmonary circulation may already be overloaded, and there may be reabsorption of edema fluid from previously dependent parts of the body. Pulmonary congestion decreases when the patient assumes a more erect position, and this is accompanied by an improvement in symptoms.

Orthopnea may be related to cardiac conditions, including hypertensive heart disease and congestive heart failure. A patient with hypertensive heart disease has a weakened heart that is less capable of pumping blood throughout the body. When he lies down, blood volume is redistributed throughout the body, making it more challenging for the heart to pump blood away from the lungs. This can cause shortness of breath. A patient with congestive heart failure may have a similar experience when lying down and can also awaken breathless because of orthopnea.

Another cause of orthopnea may include a medical condition called cor pulmonale. This cardiac condition refers to when the right-sided heart starts to fail because of high blood pressure in the arteries of the lung. Typically, high blood pressure in the pulmonary arteries can contribute to difficulty breathing because it can causes wheeze and coughing. Sometimes oxygen therapy may be indicated to assist with breathing, greatly relieving orthopnea.


If you are not sure if you are having orthopnea, please refer to the most common signs and symptoms of the disease.

  • Shortness of breath if laid flat.
  • Swollen feet.
  • Swollen ankle.
  • Want to have many pillows when sleeping, or want to sleep with the upper body is elevated.
  • Coughing regularly.
  • Having intermittent chest pain.
  • Dysphasia.
  • Hoarseness.
  • Experiencing regular palpitations.
  • Cyanosis.


The initial approach to evaluation begins by assessment of the airway, breathing, and circulation followed by a medical history and physical examination.Signs that represent significant severity include hypotension, hypoxemia, tracheal deviation, altered mental status, unstable dysrhythmia, stridor, intercostal indrawing, cyanosis, and absent breath sounds.

A number of scales may be used to quantify the degree of orthopnea.It may be subjectively rated on a scale from 1 to 10 with descriptors associated with the number. Alternatively, a scale such as the MRC Breathlessness Scale might be used - it suggests five different grades of orthopnea based on the circumstances in which it arises.

A number of labs may be helpful in determining the cause of orthopnea. D-dimer while useful to rule out a pulmonary embolism in those who are at low risk is not of much value if it is positive as it may be positive in a number of conditions that lead to shortness of breath.A low level of brain natriuretic peptide (BNP) is useful in ruling out congestive heart failure; however, a high level while supportive of the diagnosis could also be due to advanced age, renal failure, acute coronary syndrome, or a large pulmonary embolism.

Imaging: A chest x-ray is used to confirm or rule out a pneumothorax, pulmonary edema, or pneumonia. Spiral computed tomography with intravenous radiocontrast is the imaging study of choice to evaluate for pulmonary embolism.


Normally, people will treat their own discomfort by adjusting the height of their head or upper body while sleeping. They normally want to have an elevated position that will make them easy to breathe. Doing this will surely help, but of course, this is just a temporary relief to the discomfort. It may worsen as you go along that is why it is just important and highly recommended that you seek a doctor or a professional to talk about the different treatments that will work for you and your budget.


Some of the treatments for this kind of disorder would be:

  • Anti-inflammatory medication.
  • Pericardiocentesis.
  • Open heart surgery

The said treatments are actually bank breaking types of treatments because it will definitely cost a fortune. We suggest that after seeking advice from your doctor; call your health insurance to ask if any of the following recommended options for treating your disorder will be covered by your insurance. That way, you can be sure to budget your expense and balance out everything before deciding on which type of procedure will you undergo. However, if you are left with no option, meaning - all it is left is to undergo a painful surgery to both your body and pocket, then we suggest that you seek help from family and friends who are willing to help and support you financially.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


  1. budour

    i want priority question that orthopnea ?

    • maisteri

      Could you explain please what do you mean?


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