Symptoms and mechanisms
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Orthopnoea
Recumbency redistributes blood from peripheral venous reservoirs towards the thorax. In a vulnerable left heart, filling pressure and pulmonary venous pressure rise.
Bendopnoea
Bending forward can rapidly increase right atrial and pulmonary capillary wedge pressures when baseline filling pressures are already high.
Paroxysmal nocturnal dyspnoea
Prolonged recumbency and mobilisation of dependent oedema may increase pulmonary congestion over several hours.
Peripheral oedema
Raised systemic venous pressure, sodium retention and increased capillary filtration can overwhelm lymphatic clearance.
Fatigue
Reduced cardiac output reserve, skeletal-muscle dysfunction, iron deficiency and comorbidity may all contribute.
Exertional breathlessness
Exercise may provoke increases in left-sided filling pressures, impaired output reserve and increased ventilatory drive.
Abdominal fullness
Systemic venous hypertension can cause hepatic and splanchnic congestion, gut oedema and early satiety.
Nocturia
During recumbency, dependent fluid can return to the circulation and influence renal perfusion and nocturnal urine production.