Which symptom indicates orthopnea, a classic sign of heart failure?

Which symptom indicates orthopnea, a classic sign of heart failure?

• A. Shortness of breath worsens with exertion
• B. Chest pain worsens with deep breathing
• C. Wheezing improves with bronchodilator
• D. Shortness of breath worsens when lying flat

Answer: (D)

Orthopnea is dyspnea that worsens when lying flat because lying down increases venous return to the heart. In left-sided heart failure, the weakened ventricle can’t handle this extra preload, leading to pulmonary congestion and shortness of breath in the supine position. That’s why the symptom described as shortness of breath that gets worse when lying flat is the hallmark of orthopnea. Shortness of breath with exertion, by contrast, is more about limited cardiac output during activity rather than a positional change. Chest pain with deep breathing points to a pleuritic process rather than heart failure. Wheezing that improves with a bronchodilator suggests reversible airway obstruction rather than orthopnea.

Orthopnea is dyspnea that worsens when lying flat because lying down increases venous return to the heart. In left-sided heart failure, the weakened ventricle can’t handle this extra preload, leading to pulmonary congestion and shortness of breath in the supine position. That’s why the symptom described as shortness of breath that gets worse when lying flat is the hallmark of orthopnea.

Shortness of breath with exertion, by contrast, is more about limited cardiac output during activity rather than a positional change. Chest pain with deep breathing points to a pleuritic process rather than heart failure. Wheezing that improves with a bronchodilator suggests reversible airway obstruction rather than orthopnea.