In patients with diminished left ventricular ejection fraction or in cardiac dysfunction when the blood is redistributed to the pulmonary circulation in the supine position, the heart cannot pump the excess blood out, resulting in pulmonary congestion and dyspnoea (Orthopnoea
A general anaesthetic technique was chosen because the patient could not lie flat due to severe orthopnoea
. Furthermore, neuraxial anaesthesia has not been well described in this subset of patients and the effects were unpredictable.
A 45 years old male, snuff user, banker by profession, known case of valvular heart disease, presented in the cardiothoracic clinic of Aga Khan University Hospital, on 18 February 2013 with worsening exertion dyspnoea, orthopnoea
, syncope and palpitation since 1 year.
All the patients underwent a detailed history of fever, productive or dry cough, night sweats, haemoptysis, chest pain, weight loss, lower extremity oedema, orthopnoea
, paroxysmal nocturnal dyspnoea, decreased urine output, and other relevant symptoms.
She had been too weak to walk for 3 weeks on admission, and described symptoms of paroxysmal nocturnal dyspnoea and orthopnoea
. On examination, she had a sinus tachycardia with normal blood pressure and chest and cardiac auscultations.
A previously healthy 71-year-old female was admitted to hospital following a presentation of acute congestive cardiac failure after a short history of worsening dyspnoea, orthopnoea
and leg oedema.
There was no history of cough, orthopnoea
, fever, night sweats or cyanosis.
We should be cautious in carotid sinus syncope, severe back pain, recent stroke, coronary bypass within 3 months, severe neck pain, recent neck surgery, cervical myelopathy, severe back pain, severe orthopnoea
. The test should be performed using direct observation of eye movements and with optic fixation.
Symptoms such as increased shortness of breath, decreased effort tolerance, orthopnoea
, paroxysmal nocturnal dyspnoea, syncope, palpitations and chest pain are all potential indicators of CD.
A 52-year-old man presented with neck and face swelling, dyspnoea and orthopnoea
. Thymic cancer complicated by superior vena cava (SVC) syndrome was diagnosed.
Dyspnoea was the most common presenting symptom (100%) followed by easy fatigability observed in (66.6%), orthopnoea
in (58.3%), pedal oedema in (54.2%), palpitations in (45.8%), cough and syncope in (29.2%) paroxysmal nocturnal dyspnoea in (25%) and chest pain in (20.8%).
Shortness of breath was associated with exertion, orthopnoea
, productive cough and palpitations.