A patient presents with orthopnea. What type of evaluation should be performed?

Orthopnea, or difficulty breathing when lying flat that improves when sitting up, is primarily associated with cardiac issues, specifically heart failure. Evaluating a patient with orthopnea typically involves focusing on potential cardiac dysfunction since this condition often indicates an overload of fluid in the lungs due to compromised heart function.

A cardiac evaluation would include assessing the patient's history for symptoms such as paroxysmal nocturnal dyspnea, reviewing vital signs, conducting a physical examination for signs of heart failure (like jugular venous distension), and possibly ordering tests like an echocardiogram or chest X-ray to look for signs of left-sided heart failure or pulmonary congestion.

While pulmonary evaluations can also be important in the diagnosis of dyspnea, in the case of orthopnea, the underlying causes are more often rooted in cardiac issues. Neurological evaluations and gastrointestinal evaluations are generally not relevant in the context of orthopnea, as they do not directly relate to the primary causes of this symptom. Thus, focusing on a cardiac evaluation allows for an accurate understanding of the underlying issues that may be contributing to the patient's discomfort.