Orthopnea

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of orthopnea

Dyspnea necessitates ‍ ‍pillows

Onset was ‍gradualsudden

Pattern ‍constant (every night)intermittent

Alleviating factors: ‍nonesitting uprightextra pillows, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍paroxysmal nocturnal dyspnea

‍leg edema, ‍rightleftsymmetrical

‍shortness of breath on exertion, ‍IIIIIIIV/IV

‍wheezing

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍chest tightness

‍palpitations

‍syncope

‍dizziness

‍coughing

‍cyanosis



Contributing factors:

‍non-adherence to low salt intake

‍non-adherence to low liquid intake

no history of: ‍heart failure, ‍CAD, ‍valvular heart disease, ‍kidney insufficiency, ‍severe liver disease, ‍COPD, ‍sleep apnea, ‍obesity

no use of: ‍diuretics, ‍calcium-channel blockers, ‍steroids, ‍new medication

no recent change in ‍diuretics dose





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Heart failure ‍likelysuspectedpossible

DDx: heart failure, pulmonary hypertension, obstructive sleep apnea, COPD, asthma, pneumonia, diaphragmatic paralysis, neuromuscular disorders, obesity hypoventilation syndrome, anxiety/panic disorder, GERD, cardiac ischemia, valvular heart disease, pericardial effusion, cardiomyopathy, interstitial lung disease, pulmonary embolism, scoliosis, kyphosis





PLAN:

Investigations:

- ECG

- Chest X-ray

- Blood work: ‍CBC, ‍D-dimer, ‍troponin, ‍BNP, ‍blood gas, ‍electrolytes, ‍creatinine, ‍glucose, ‍TSH

- Echocardiogram

- Cardiac catheterization

- Pulmonary function tests

- Sleep study

Treatments:

- ‍Diuretics

- Fluid restriction

- Reduce salt intake

Further care:

- Referral to pulmonologist

- Referral to cardiologist

- Follow-up in ‍ ‍daysweeksmonths

- Return if orthopnea worsens or if new symptoms develop such as chest pain, palpitations, or syncope