Orthopnoea: Your heart may be trying to tell you something…

Dr Sahil Sareen, Senior Cardiologist at NHS Hospital, shares key insights on orthopnoea, its cardiac connection and how timely intervention can transform lives.

Orthopnea, though often ignored, requires immediate attention. No one should have to fear bedtime because of breathlessness. In my experience, with early detection, expert care and the availability of advanced cardiac technology, patients genuinely have a chance to sleep peacefully at night—and with that, live a healthier life.

Orthopnea—shortness of breath when lying flat—is more than just a disturbance to sleep. It’s often a loud and clear warning sign of underlying heart failure or serious cardiac dysfunction. Managing this issue effectively means having a deep understanding of cardiovascular disease, a readiness to diagnose promptly and access to innovative interventions.

The term “orthopnoea” comes from the Greek words “ortho” (straight) and “pnoea” (breath), and it refers to the struggle to breathe when lying down. Many people tend to dismiss this symptom, assuming it’s just due to fatigue or a minor respiratory issue. But in my practice as a cardiologist, orthopnoea is one of the key clinical signs that can indicate the early stages of congestive heart failure—especially left-sided heart failure. It typically results from fluid build-up in the lungs (pulmonary congestion), which occurs when the heart’s ability to pump blood effectively is compromised.

Orthopnoea, by itself, is not a diagnosis—it’s a red flag. It’s the body’s way of signalling that the heart is under duress. And I can say from my own work that timely detection and intervention can significantly change a patient’s prognosis.

One of the most transformative tools I use today is the 3D Cath Lab. It has completely changed the game in interventional cardiology and how we conduct precision diagnosis. With the 3D Cath Lab, I now get a live, dynamic and rotatable view of the coronary anatomy—something that was unimaginable just a few years ago.

Path to recovery

A recent case still stands out in my memory. A 62-year-old man from Phagwara had been experiencing severely disturbed nights for nearly two months due to orthopnoea.

Using the 3D Cath Lab, I was able to detect critical coronary artery blockages and identify impaired left ventricular function through echocardiography. We performed a minimally invasive angioplasty and placed drug-eluting stents. His recovery was nearly immediate—the heart’s pumping efficiency improved, and his orthopnoea symptoms vanished. For the first time in months, he was finally able to sleep soundly.

Early detection matters

One thing I’ve come to realise over the years is that many people mistake orthopnoea for a respiratory illness or a normal part of ageing. There’s a real need to raise awareness about this symptom and educate people on when to seek help.

I believe we must hold community outreach programmes, free heart check-up camps and public seminars to create awareness about early signs of heart failure, the risks involved, lifestyle changes and the urgency of timely diagnosis. If someone begins to need multiple pillows just to sleep or wakes up breathless in the night, it’s not something to ignore. They must consult a cardiologist immediately. The sooner we intervene, the better the outcomes.

Future of cardiology

I’m also excited about where cardiology is headed. With digital health records, remote cardiac monitoring and the coming wave of AI-driven predictive modelling, our approach is shifting.

We’re moving from being reactive to becoming proactive. My goal is to ensure that conditions like orthopnoea are identified even before they fully manifest—so that fear, discomfort, and sleepless nights become a thing of the past.

Jalandhar