Paroxysmal nocturnal dyspnea or paroxysmal nocturnal dyspnoea ( PND ) is an attack of severe shortness of breath and coughing that generally occurs at night. It usually awakens the person from sleep, and may be quite frightening. PND, as well as simple orthopnea , may be relieved by sitting upright at the side of the bed with legs dangling, as symptoms typically occur when the person is recumbent, or lying down.
32-973: PND may refer to: Medicine [ edit ] Paroxysmal nocturnal dyspnoea , a breathing disorder Post-nasal drip , from the nose Politics [ edit ] New Democracy Party (Portugal) ( Partido da Nova Democracia ) National Democratic Party (Djibouti) ( Parti National Démocratique ) Democratic Nationalist Party (Romania) , dissolved Transport [ edit ] Pending LRT station (LRT station abbreviation), Bukit Panjang, Singapore Punta Gorda Airport (IATA code), Belize Other uses [ edit ] PartyNextDoor , Canadian singer Penalty Notice for Disorder , UK fine for anti-social offences Personal navigation device or personal navigation assistant Personennamendatei (Name Authority File) Pitcairn Islands dollar Police National Database , UK See also [ edit ] PNDS (disambiguation) Topics referred to by
64-410: A hill) to their PCP. Of these people seeing a PCP, 1-4% see their provider for dyspnea specifically. After identifying the cause of dyspnea, most people continue on to see a specialist to manage dyspnea presentation and address underlying conditions. Roughly 15-50% of people who are regularly seen by a cardiologist are seen in regard to dyspnea symptoms, while just under 60% of people regularly see
96-422: A lifestyle lacking exercise and a healthy diet. Risk factors for lung diseases include tobacco use, including second hand smoke, pollution, exposure to hazardous fumes, and allergens. PND can be explained by mechanisms similar to those of orthopnea and typical dyspnea. When a person is recumbent, or is lying down, blood is redistributed from the lower extremities and abdominal cavity ( splanchnic circulation ) to
128-500: A meter in length in humans. The longest axon in the human body belongs to the Sciatic Nerve and runs from the great toe to the base of the spinal cord. These are archetypal examples of neural pathways. Neural pathways in the basal ganglia in the cortico-basal ganglia-thalamo-cortical loop , are seen as controlling different aspects of behaviour. This regulation is enabled by the dopamine pathways . It has been proposed that
160-589: A pneumonologist in regard to their dyspnea. Additionally, there have been epidemiological studies performed on central sleep apnea in heart failure. Central sleep apnea in heart failure's epidemiology is relevant, as sleep apnea and heart failure have both been associated in people with paroxysmal nocturnal dyspnea. According to the study, researchers were able to conclude that ~70% of people with heart failure had breathing disorders while they slept, while half of that ~70% also experienced central sleep apnea with Cheyne Stokes respiration (CSA-CSR). Atrial fibrillation ,
192-412: A signal from one region of the nervous system to another). Neurons are connected by a single axon, or by a bundle of axons known as a nerve tract , or fasciculus . Shorter neural pathways are found within grey matter in the brain , whereas longer projections, made up of myelinated axons, constitute white matter . In the hippocampus , there are neural pathways involved in its circuitry including
224-473: Is central sleep apnea (CSA) with Cheyne-Stokes Breathing (CSB), for which the treatment recommended by the American Academy of Sleep Medicine is continuous positive airway pressure ( CPAP ) and nocturnal home oxygen therapy (HOT). The shortness of breath sensation felt from PND can typically be relieved by maintaining an upright position while sleeping. While a small source of data exists on
256-465: Is a combination of rare complications that are explained by an increased amount of serum and persistent tissue eosinophilia. An uncommon disorder that is known to be associated with Hypereosinophilic Syndrome is Löffler endocarditis . Neural pathway In neuroanatomy , a neural pathway is the connection formed by axons that project from neurons to make synapses onto neurons in another location, to enable neurotransmission (the sending of
288-530: Is achieved through a physical examination, electrocardiography, chest radiograph, and if necessary, a serum BNP level. As a subjective symptom self-reported by people, dyspnea is difficult to characterize since its severity cannot be measured. Dyspnea can come in many forms, but it is commonly known as shortness of breath or having difficulty breathing. People presenting with dyspnea usually show signs of rapid and shallow breathing, use of their respiratory accessory muscles, and may have underlying conditions causing
320-438: Is based primarily on its origin (in the primary motor cortex , Brodmann area 4) and termination (onto the alpha motor neurons of the spinal cord ). In the cerebellum , one of the two major pathways is that of the mossy fibers . Mossy fibers project directly to the deep nuclei , but also give rise to the following pathway: mossy fibers → granule cells → parallel fibers → Purkinje cells → deep nuclei. The other main pathway
352-411: Is different from Wikidata All article disambiguation pages All disambiguation pages Paroxysmal nocturnal dyspnoea Since paroxysmal nocturnal dyspnea occurs mainly because of heart or lung problems, common risk factors include those that affect the function of the heart and lungs. Risk factors for cardiac diseases include high blood pressure, high cholesterol, diabetes, obesity, and
SECTION 10
#1732787721969384-428: Is from the climbing fibers and these project to Purkinje cells and also send collaterals directly to the deep nuclei. In general, neurons receive information either at their dendrites or cell bodies . The axon of a nerve cell is, in general, responsible for transmitting information over a relatively long distance. Therefore, most neural pathways are made up of axons . If the axons have myelin sheaths, then
416-452: Is properly identified, it is important to differentiate between acute and chronic dyspnea, typically through a detailed physical exam and observation of the person's breathing patterns. The most common causes of dyspnea are cardiac (cardiac asthma) and pulmonary conditions, like congestive heart failure with preserved ejection fraction , COPD , or pneumonia . Less commonly, some cases of dyspnea can be attributed to neuromuscular diseases of
448-476: Is theorized to be a complicated connection between peripheral receptors, neural pathways , and the central nervous system . Receptors in the chest wall and central airways, as well receptors in the respiratory center of the central nervous system, produce an increased requirement for ventilation which is not matched by respiratory output, resulting in the conscious recognition of dyspnea. Respiratory muscles and vagal afferent neural pathways relay information from
480-510: Is typically a red flag that something more serious is causing the dyspnea presentation and should be evaluated further. Paroxysmal nocturnal dyspnea is a common symptom of several heart conditions such as heart failure with preserved ejection fraction, in addition to asthma , chronic obstructive pulmonary disease , and sleep apnea . Other symptoms that may be seen alongside paroxysmal nocturnal dyspnea are weakness, orthopnea, edema, fatigue, and dyspnea. Dyspnea affects about 25% of people in
512-460: The perforant pathway , that provides a connectional route from the entorhinal cortex to all fields of the hippocampal formation , including the dentate gyrus , all CA fields (including CA1), and the subiculum . Descending motor pathways of the pyramidal tracts travel from the cerebral cortex to the brainstem or lower spinal cord . Ascending sensory tracts in the dorsal column–medial lemniscus pathway (DCML) carry information from
544-401: The respiratory center in the brain and decreased adrenergic activity in the myocardium during sleep. Paroxysmal nocturnal dyspnea is a serious medical symptom that can develop into worsening conditions. Many tests can be done in order to evaluate the cause of paroxysmal nocturnal dyspnea. Because it is commonly associated with heart failure , tests that may be run mainly focus on measuring
576-411: The thalamus , and finally terminating in the cerebral cortex . Sometimes, these two naming conventions coexist. For example, the name " pyramidal tract " has been mainly supplanted by lateral corticospinal tract in most texts. Note that the "old" name was primarily descriptive, evoking the pyramids of antiquity, from the appearance of this neural pathway in the medulla oblongata . The "new" name
608-426: The "huge" statue), anterior commissure , and posterior commissure . Further examples include the pyramidal tract , crus cerebri ( Latin , "leg of the brain"), and cerebellar peduncles ( Latin , "little foot of the cerebellum "). Note that these names describe the appearance of a structure but give no information on its function, location, etc. Later, as neuroanatomical knowledge became more sophisticated,
640-460: The ambulatory care setting and is a common symptom of many underlying conditions. Dyspnea is a subjective symptom, meaning it can only be expressed by the person experiencing it, and it is imperative in diagnosis to distinguish it from other breathing problems. Dyspnea is typically the sensation of feeling short of breath and should not be confused with rapid breathing ( tachypnea ), excessive breathing ( hyperpnea ) or hyperventilation . Once dyspnea
672-531: The chest wall or anxiety. When distinguishing PND from typical dyspnea, it is important to identify common characteristics of PND. Some important criteria to identify are temporal characteristics (i.e., acute or chronic onset, intermittent or persistent symptoms), situational characteristics (i.e., symptoms at rest, upon exertion, upon different body positions, or upon special exposures), and pathogenic characteristics (i.e., physiologic or mental conditions). PND typically presents at night during sleep, especially while
SECTION 20
#1732787721969704-610: The chest wall/airways to the central nervous system, facilitating the presentation of dyspnea. In people with underlying congestive heart failure , this redistribution may overload the pulmonary circulation, causing increased pulmonary congestion . In congestive heart failure, left ventricular dysfunction will also increase pulmonary congestion, so further congestion caused by the redistribution of blood volume upon laying down will worsen any dyspnea. Other theories exist for why PND occurs, especially in those where PND only occurs while sleeping. Theories include decreased responsiveness of
736-446: The dyspnea, such as cardiac or pulmonary diseases. With paroxysmal nocturnal dyspnea specifically, it is felt while sleeping and causes a person to wake up after about 1 to 2 hours of sleep. More serious forms of dyspnea can be identified through accompanying findings, such as low blood pressure, decreased respiratory rate, altered mental status, hypoxia, cyanosis, stridor, or unstable arrhythmias. When these symptoms accompany PND, it
768-399: The function and capability of the heart. Common tests may include an echocardiography, cardiac magnetic resonance imaging (MRI), coronary artery angiogram, chest x-ray or chest CT scan, blood tests, physical exams, or a myocardial biopsy. The diagnostic workup will vary depending on the suspected cause. For example, for people who enter the emergency room with shortness of breath, a diagnosis
800-450: The lungs. Failure to accommodate this redistribution results in decreased vital capacity and pulmonary compliance , further causing the shortness of breath experienced in PND. In addition to the redistribution of blood in the body, most cases of dyspnea are accompanied by an increase in the overall work of breathing, often caused by abnormal pulmonary mechanisms. The perception of dyspnea
832-436: The male gender, an age greater than 60, and awake PaCO 2 being less than or equal to 38 mm Hg were all risk factors associated with CSA-CSR. Pregnancy In people who are pregnant, the presence of paroxysmal nocturnal dyspnea is abnormal. Further investigation and diagnostic tests should be done in order to prevent harm to the fetus and to the mother. Hypereosinophilic Syndrome (HES) Hypereosinophilic syndrome
864-414: The pathway appears bright white because myelin is primarily lipid . If most or all of the axons lack myelin sheaths (i.e., are unmyelinated ), then the pathway will appear a darker beige color, which is generally called grey . Some neurons are responsible for conveying information over long distances. For example, motor neurons , which travel from the spinal cord to the muscle, can have axons up to
896-513: The periphery to the cortex of the brain. The first named pathways are evident to the naked eye even in a poorly preserved brain , and were named by the great anatomists of the Renaissance using cadaver material. Examples of these include the great commissures of the brain such as the corpus callosum ( Latin , "hard body"; not to be confused with the Latin word "colossus" –
928-404: The person is laying down, distinguishing PND from typical dyspnea. Treatment for paroxysmal nocturnal dyspnea depends on the underlying cause. If the underlying cause is heart failure with preserved ejection fraction ( HFpEF , when part of the heart does not fill properly with blood), treatments can include diuretics, beta blockers, and ACE inhibitors. Another potential underlying cause of PND
960-566: The prevalence of PND, a large pool of data exists on the epidemiology of dyspnea in general. Reports show that 7.4% of people reporting to the emergency room identify dyspnea as one of their symptoms, with 1-4% of people identifying dyspnea as their primary concern. Dyspnea is often the cause of situational changes in a person's environment or activity. For example, 10% of people complain of dyspnea while walking on flat ground to their primary care provider (PCP), while 25% of people complain of dyspnea upon more intense exertion (i.e. climbing stairs or
992-449: The same term [REDACTED] This disambiguation page lists articles associated with the title PND . If an internal link led you here, you may wish to change the link to point directly to the intended article. Retrieved from " https://en.wikipedia.org/w/index.php?title=PND&oldid=1240691597 " Category : Disambiguation pages Hidden categories: Articles containing German-language text Short description
PND - Misplaced Pages Continue
1024-493: The trend was toward naming pathways by their origin and termination. For example, the nigrostriatal pathway runs from the substantia nigra ( Latin , "black substance") to the corpus striatum ( Latin , "striped body"). This naming can extend to include any number of structures in a pathway, such that the cerebellorubrothalamocortical pathway originates in the cerebellum , synapses in the red nucleus ("ruber" in Latin), on to
#968031