A Significant Reduction In Blood Flow To The Brain What Is Paroxysmal Nocturnal Dyspnea?

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What Is Paroxysmal Nocturnal Dyspnea?

First, yes, it’s a tongue-twister, it took me a few tries before I could pronounce it correctly, not to mention it sounds like a horrible zombie disease! So, what exactly does this mean? To break it down simply – paroxysmal means a sudden outbreak or attack; Nocturnal means nocturnal and dyspneic means shortness of breath. Collectively, paroxysmal nocturnal dyspnea (PND) is a feeling of lack of oxygen during sleep, the lack of oxygen causes a person to cough and wheeze, which significantly increases diastolic pressure.

So it’s not a zombie disease, but most people would say it’s scary. PND is a common symptom of congestive heart failure. A person suffering from PND needs urgent medical attention – calling an ambulance is the first immediate step, however other treatments to calm the episode may include taking nitroglycerin and diuretics.

PND has similar symptoms to obstructive sleep apnea syndrome (OSA), however it is not a separate disease. PND is very different, a severe clinical syndrome that is directly related to heart failure.

People suffering from obstructive sleep apnea syndrome have a significant decrease in the tone of their airway muscles during sleep, which causes the airway to become obstructed. This leads to respiratory arrest where breathing stops.

During such pauses, the amount of oxygen in the blood decreases and the respiratory center receives signals that the tissue is in a state of hypoxia. After 10-20 seconds, the oxygen level in the blood drops to a minimum and this finally causes the body to react to the situation. Microstimulation of the brain increases the tone of the muscles of the upper respiratory tract which aids in breathing. For several seconds thereafter, the sleeper’s breathing is frequent and deep. At this time, the person also experiences shortness of breath, even if they do not wake up.

Paroxysmal Nocturnal Dyspnea Causes?

Paroxysmal nocturnal dyspnea is common in older people with heart problems, however, it can happen to anyone who has:

  • Left ventricular failure during acute phase;

  • acute myocardial infarction;

  • acute myocarditis;

  • Aneurysms of the heart;

  • Postpartum cardiomyopathy;

  • cardiosclerosis;

  • mitral stenosis;

  • Aortic insufficiency;

  • Presence of large intracardiac thrombus or tumor.

Factors that may cause a PND episode in a person with the medical problems listed above include:

  • pneumonia;

  • kidney damage;

  • Cerebral circulatory disorders;

  • emotional overwork;

  • Big dinner;

  • hypervolemia;

  • Rapid change in body position from vertical to horizontal.

What are the symptoms of paroxysmal nocturnal dyspnea?

The most common symptoms of PND include:

  • intermittent sleep;

  • dyspnea with physical exertion;

  • shortness of breath at night when lying down, but relieved when sitting up;

  • cough with wheezing;

  • production of sputum, sometimes with blood;

  • whistling in the lungs;

  • Constant feeling of lack of air;

  • chest pain;

  • Arrhythmia;

  • Swelling of the feet;

  • Fatigue and drowsiness.

An episode typically occurs as follows: A person wakes up from a nightmare, feels a tightness in the chest and wants to sit up, their breathing is deep and labored. Narrowing of the bronchioles causes difficulty breathing, making it difficult for the person to speak. When sitting, the person usually leans slightly forward. Spasms of superficial blood vessels make their skin pale and sometimes sweaty. PND can start suddenly and stop suddenly within half an hour. The person may suffer from dyspnea on waking up in the morning.

Why does paroxysmal nocturnal dyspnea cause these symptoms?

During sleep in a person with heart problems, body fluid begins to redistribute from the tissues into the blood, which accumulates in the legs or abdominal cavity during the day. This process is not rapid so symptoms do not appear immediately after falling asleep. Paroxysmal dyspnea develops slowly after a long time after falling asleep.

In people with heart failure, the left side of the heart does not work at full capacity, so the small circle of blood circulation cannot cope with the extra volume of fluid. This amount remains in the extra pulmonary vessels. This excess volume then moves through the vessels into the lung tissue, leading to the development of interstitial pulmonary edema.

The most severe form of paroxysmal dyspnea is acute pulmonary edema, which develops due to increased pressure in the pulmonary capillaries and causes alveolar edema. Typical symptoms of pulmonary edema are severe shortness of breath, wet wheezing and bloody sputum. Acute pulmonary edema can quickly lead to death.

How to treat paroxysmal nocturnal dyspnea?

Before treatment, a thorough medical evaluation is important to determine the cause of paroxysmal nocturnal dyspnea. Proper examination, medical history, chest x-ray, ECG, cardiac ultrasound and cardiac doppler are very important for accurate diagnosis.

During acute paroxysmal nocturnal dyspnea episodes, it is imperative to call an ambulance due to the high risk of developing pulmonary edema. First aid for the person includes keeping them still, keeping them in a semi-sitting position, and placing their feet in a warm bath. Give the person sublingual nitroglycerin and repeat the medication every 5-10 minutes. If the attack is accompanied by pain and shortness of breath, pain relievers may also be used. Further therapy can be done depending on the cause of the disease.

Common recommendations for preventing paroxysmal nocturnal dyspnea are smoking cessation, weight loss in obese individuals, and normalization of blood pressure levels. A strict diet high in fresh fruits and vegetables and avoiding highly salty foods is also recommended. Oxygen therapy is an effective means of disease control, not only for use in the hospital but also at home.

Disease prevention includes timely treatment of acute coronary artery disease and heart failure, arterial hypertension, adherence to water-salt rules, prevention of infectious diseases.

A thorough medical evaluation is essential to ensure that the correct syndrome is diagnosed, so if you think you have obstructive sleep apnea symptoms, it could be PND, so get checked out properly by a doctor.

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