Orthopnea

Shortness of breath that occurs when lying flat and improves when sitting upright or standing.

Causes

• Cardiac causes

  • Left-sided heart failure (classic cause)

  • Pulmonary venous congestion

  • Cardiogenic pulmonary edema

  • Dilated cardiomyopathy

  • Valvular heart disease (especially mitral valve disease)

  • Pericardial disease affecting cardiac filling

• Pulmonary causes

  • Chronic obstructive pulmonary disease

  • Severe asthma

  • Pneumonia

  • Interstitial lung disease

  • Pulmonary fibrosis

  • Pleural effusion

• Mechanical and restrictive causes

  • Obesity-related reduced diaphragmatic movement

  • Diaphragmatic paresis or paralysis

  • Large abdominal distension limiting lung expansion

  • Ascites

  • Abdominal masses

• Obstructive sleep apnea

• Neuromuscular disorders causing respiratory muscle weakness

• Anxiety-related breathing disorders

• Severe deconditioning

• Pregnancy-related respiratory changes