An adult patient has a history of heart failure. Which symptom would you suspect?

• A. Swollen feet and ankles
• B. Shortness of breath when active
• C. Chest pain
• D. Difficulty breathing when lying down

Answer: (D)

Orthopnea, or difficulty breathing when lying flat, is a classic sign of heart failure. When you lie down, fluid that’s been pooling in the legs and abdomen shifts toward the chest, increasing venous return and pulmonary congestion, which makes breathing harder. That’s why patients with heart failure often need to sleep propped up or with extra pillows. Peripheral swelling can happen, but it isn’t as specific to heart failure as recumbent dyspnea. Chest pain isn’t typically a primary symptom of heart failure and would point toward other conditions.