Which symptom is most characteristic of orthopnea, a feature often seen in congestive heart failure?

• A. Orthopnea
• B. Edema
• C. Syncope
• D. Palpitations

Answer: (A)

Orthopnea is dyspnea that worsens when lying flat and improves when upright or with head elevation. In congestive heart failure, especially with left-sided failure, lying down increases venous return to the heart, raising left atrial and pulmonary pressures and causing pulmonary congestion and shortness of breath. Sitting up reduces venous return and relieves the symptoms, which is why this positional dyspnea is the hallmark feature. The other options can occur with heart failure but do not describe the characteristic positional nature of orthopnea (peripheral edema reflects fluid overload, syncope is fainting, and palpitations are sensations of an irregular heartbeat).