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
| Diagnosis | Evidence |
|---|---|
| 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. |