Hello,

Welcome back to DoctorSpring.
I just referred back your old consult.

As I understand you again had this middle of the night breathlessness, but now without any flu.
I will try my best to help you here. I need some additional information from you so that I can provide a solid and learned opinion. Broadly this breathlessness can be of either cardiac or respiratory origin.

1. Do you have any swelling of legs ? / any decreased urine output ?
2. You do have an active lifestyle. Recently (in last 3-4 weeks) during your workout / walks, ever noticed that you are getting fatigued more easily ? Or a reduction in performance ?
3. Have you had an ECG done recently (in last 1 year or so). If so was it normal ?
4. Do ever feel that sleeping in a slightly more propped up position is more comfortable ? (Like with a pillow or back rest)
5. When was the last time you had an annual physical ? Was everything normal at that time ?
6. Is there any palpitations ? Feel of rapid heart beat ?

You can reply as a followup
Thank you

Hello Duke,

As I said earlier - There are two major aetiologies for this kind of breathlessness - Cardiac and Respiratory. The PND symptoms come under the cardiac causes.

From the symptoms you have mentioned we can say that I am 98% sure that this is NOT a cardiac cause. The symptoms are not suggestive of PND. PND (and cardiac asthma or breathlessness ) occurs in heart failure (specifically left heart failure). in that case there will be associated symptoms and noticeable decrease in exercise tolerance for sure. You do not have any of the associated symptoms or suggestive signs.

And it will never be paroxysmal ( not like couple of episodes with normal time period in between). In PND / cardiac cause there will be a gradually progressive or at least static symptoms. Since your symptoms occurred only twice the cause is more likely to be respiratory.

A respiratory cause is more likely and it is not as worrisome as a cardiac cause. It could be an asthma like reaction to an allergen. Determining the exact cause might not be bit difficult. Other rare cause is a panic attack / anxiety attack.

There is a 2% or less chance for a cardia cause like a valvular heart disease or an arrhythmia to manifest like this. So in order to rule out these and to find out the exact cause it is better to under go a baseline evaluation and some tests. Pulmonary Embolism is also a rare possibility, which can be ruled out by these tests.

I would recommend :

1. Physical Examination
2. ECG
3. ECHO
4. Venous Doppler
5. PFT (Pulmonary Function test)

Please note, that all these tests are not necessary. Your Doctor can decide on after a Physical examination and ECG. If the symptoms does not recur you may wait till your annual physical.

Bottom-line is that, the symptoms are not suggestive of PND, but it is prudent to have a baseline evaluation just to be sure.

Hope this helps
Feel free to ask followups
Thank you

Thank you for your kind words.
Please note this consult will stay open. If there is anything more you can just ask me as a followup question.

Wish you good health !