The challenge of correcting volume overload in hospitalized patients with decompensated heart failure. Elkayam U, Hatamizadeh P, Janmohamed M.Early ultrafiltration in patients with decompensated heart failure and diuretic resistance. Costanzo MR, Saltzberg M, O'Sullivan J, et al. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. Costanzo MR, Guglin ME, Saltzberg MT, et al.Diagnosis of heart failure in older adults: predictive value of dyspnea at rest. Ahmed A, Allman RM, Aronow WS, et al.Next, we'll learn what causes paroxysmal nocturnal dyspnea and how you can treat it. It commonly occurs several hours into sleep (as opposed to immediately upon lying down), and it's relieved by sitting upright, but not as quickly as is orthopnea. Paroxysmal nocturnal dyspnea is an intense form of orthopnea. People with this condition must keep their heads elevated to breathe comfortably. Some patients who experience paroxysmal nocturnal dyspnea also experience orthopnea: breathlessness when lying down that is relieved when several pillows raise the head and upper body. It's caused by congestion (excessive or abnormal accumulation of blood) in the lungs, perhaps along with accumulation of excess fluid in the lungs ( pulmonary edema), which occurs as a result of left-sided heart failure. Paroxysmal nocturnal dyspnea can be accompanied by swelling of the feet or ankles. While asthma is a chronic condition caused by inflammation of the airways, which can lead to breathing difficulties, paroxysmal nocturnal dyspnea is a sign of heart failure. This term is actually misleading - the two conditions are very different. Paroxysmal nocturnal dyspnea is also sometimes called cardiac asthma because its signs and symptoms mimic those of asthma.
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