Helped Over 500,000 patients with 98%+ satisfaction.

Connect & Get Personalized 1-to-1 Answers from Expert Doctors

DoctorSpring > Question Home

Paroxysmal Nocturnal Dyspnea

Resolved Question:

Greetings...

On 7 January 2014 I contacted you about waking-up in the middle of the night (after ~3-hours of sleep) experiencing difficulty in catching a deep breathe, which led to overall concerns about breathing in general. At that time, I also had 'pre-flu like symptoms.' Your medical advice (CD010720140363) was very comforting and after an hour (and taking Afrin) I feel back to sleep, and have not have any issues sleeping since that time...until tonight.

Tonight I feel asleep for ~3-hours, and again woke-up with the feeling that I could not breathe fully, i.e., complete cycle of inhaling/exhaling, or catch a deep breathe. I no longer have the flu, and have slept very well for the past 12-nights, i.e., the last time I reached out to you.

Having troubles getting back to sleep tonight, I began researching the internet regarding my symptoms, and became a little concerned when I read about Paroxysmal Nocturnal Dyspnea. As I have been upright for a couple of hours now, and type this, my breathing seems more complete, and whereas I'd love to go back to bed, I feel I may face the same sensation.

I am 57-years old, 6'2", and ~245 lbs. In relatively good shape, I walk 10-12 miles per week, and lift weights every 3-days. I do have high-blood pressure, and am currently taking telmisartan, 40 mg./hydrochlorothiazide, 12.5 mg. Outside the scope of the high-blood pressure, I do not have any health issues.

Your thoughts and opinions are very much appreciated (and comforting). Thank you!

Category: Family Physician-GP

Ask Your Own Question

Category: HIV- AIDS Specialist
 30 Doctors Online

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


Patient replied :

Dr. Sebastian,

Thank you for getting back to me. Following are the answers to your questions.

(1) I do not have any swelling of the legs, and my urine output is good (I do drink a lot of water).
(2) No issues with my walking (2-3 miles, 3-4 times per week, weather permitting), nor lifting of weights. After the first 100-yards of a brisk walk, I feel like I could go on forever. Goals/outcomes are the same, i.e., have not declined in anyway.
(3) Yes. I had an EKG done last January, and will be having another (annual check-up) done in the next few weeks.
(4) I prefer to sleep on my stomach. When I try to prop up, I am just not comfortable.
(5) Last January (2013), with another due in a few weeks. Outside the scope of the 'controlled' blood pressure, nothing unusual.
(6) No palpitations.

As shared with you on 7 January (CD010720140363), I did have flu like symptoms, which included head congestion, which did make it difficult to breathe through my nose. The Afrin did work in allowing me to breathe comfortably. I did stop taking the Afrin Friday night and sleep very well.

Thank you so much for help.

Sincerely,
Duke


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


Patient replied :

Thank you very much Dr. Sebastian. I will heed your advice and call my primary care physician (internal medicine) tomorrow and schedule an appointment. I (and my wife) truly appreciate you being there for me/us. Have a wonderful weekend. Duke


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 !


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

Users who read this, also read:

Make informed and better medical decisions.

Join the 500,000 people who found a smarter, quicker way to get Answers, Recommendations & Expert Opinions.

Expert Doctors at fingertips

Recommendation on next step. Second-opinion.Multi-specialty.

Save Time

Average time for answers: 6 hours.

Save Money

$35 for typical specialist consult vs. $120 for a local appointment.

Free Follow-ups

Clarify, ask further questions for free in private conversation.

100% Satisfaction

Money back guarantee for the 1st reply. MEDNET Quality Board.

Start My Consultation

CHAT NOW

About DoctorSpring.com

Doctor Spring is a novel online Doctor consultation platform where you can get your medical questions answered by leading Doctors. Just Submit your question and rest assured that you will consult a Doctor easily. Once you submit the question, the Doctor from the concerned specialty will reply within hours. You can always ask more questions or add details with follow-up question options and make it an online doctor chat. You may use this service to consult a specialty or for getting medical second opinion. All paid services come with a MEDNET quality assurance and 100% money back guarantee.

DoctorSpring in news