What should be considered if a patient presents with orthopnea?

Orthopnea refers to the difficulty in breathing that occurs when lying flat, leading patients to seek relief by propping themselves up with pillows or sitting upright. This symptom is particularly associated with congestive heart failure due to the accumulation of fluid in the lungs when the patient is reclined, which can exacerbate shortness of breath. In congestive heart failure, the compromised heart function affects the body’s ability to manage fluid levels, resulting in pulmonary congestion and edema that becomes more pronounced in a supine position.

While conditions such as pneumonia, asthma, and pulmonary embolism may also lead to respiratory distress, they do not typically present with orthopnea as a primary symptom. Pneumonia often causes dyspnea related to infection and inflammation, asthma is associated with wheezing and reversible airway obstruction, and pulmonary embolism usually presents with sudden onset shortness of breath, chest pain, and may not specifically cause orthopnea. Thus, when evaluating a patient with orthopnea, congestive heart failure is the most relevant condition to consider.