Bendopnea: Why Am I Short of Breath After Bending Over?

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Bendopnea is shortness of breath (dyspnea) experienced within 30 seconds of bending over at the waist, for example, when tying shoes. It occurs in response to shifts in fluid and pressure on the abdomen. In 2014, it was identified as a sign of worsening heart failure, but it also can be seen with other conditions, including obesity and sleep apnea.

Bendopnea is a symptom associated with serious illness and a poor prognosis (outlook). It's important to identify and treat its underlying causes. Diuretic medications and dietary changes may help with heart failure; phosphodiesterase-5 (PDE-5) inhibitors for pulmonary arterial hypertension (PAH) can be prescribed.

This article explains bendopnea and its causes. It presents information about diagnosis and treatment of the underlying conditions that lead to bendopnea and related symptoms.

Illustration by Theresa Chiechi for Verywell Health

Bendopnea Symptoms

Shortness of breath—dyspnea—is the singular symptom of bendopnea. Researchers believe that this shortness of breath occurs when fluid pressure increases in the abdomen and chest as people with heart failure bend over. It can be accompanied by chest pressure and may lead to a sense of suffocation and anxiety.

A number of studies have identified bendopnea in the context of heart failure, and some suggest the symptom can be used to exclude other possible diagnoses. However, it has been linked with other health conditions, too, and more study is needed to fully understand what's at work with bendopnea.

Respiratory and other symptoms common in people with heart failure and those who experience bendopnea include:

  • Orthopnea (shortness of breath when lying down)
  • Paroxysmal nocturnal dyspnea (PND) (dyspnea so dramatic it can awaken a person from deep sleep)
  • Exertional dyspnea (with exercise)
  • Peripheral edema (swelling in the extremities)
  • Syncope (passing out with loss of consciousness)

Other symptoms that have been associated with bendopnea in heart failure include:

These signs and symptoms are typically associated with advancing heart failure. Ultimately, it's seen in about half of people with decompensating heart failure.

Causes

Bendopnea occurs when the heart can't compensate for fluid shifts and pressure placed on the abdomen that result when you bend over. It is related to position and elevation, which affect how the chambers in your heart (both the right and left chambers) fill with blood and pump it out to the body.

Researchers continue to study several different suspected causes, including a relationship to hypertension, atrial fibrillation heart rhythm, and the underlying diagnosis of diabetes.

Fluid Retention With Heart Failure

It's common for people living with heart failure to retain fluid, which leads to edema (swelling) in the abdomen and the extremities. Pulmonary edema (fluid buildup in the lungs) also occurs because of the heart's limited ability to pump blood.

This extra fluid can contribute to pressure changes that lead to shortness of breath.

Excess Abdominal Weight

Bendopnea also can occur in people who have large abdomens and don’t have heart failure. Studies have shown that a higher circumference measured at the abdomen is a variable associated with bendopnea, but overall body mass index (BMI) is not.

A sense of abdominal fullness is common with bendopnea. Another consideration is hepatomegaly (enlarged liver) in the abdomen, but there is not yet evidence for its presence in people experiencing bendopnea.

Lung Conditions

Certain lung and respiratory conditions also may be related to symptoms of bendopnea. They include:

  • Pulmonary fibrosis (scarring of the lung tissue): PF limits breathing capacity and symptoms can be made worse when bending over.
  • Pulmonary arterial hypertension (PAH, affecting arteries in and around the lungs): One study found a third of people with PAH had bendopnea, associated with worse respiratory function.
  • Obstructive sleep apnea: A 2021 study of 95 people, seen at a sleep clinic for their severe sleep apnea, found a third of them had bendopnea symptoms. The bendopnea also appeared related to age, obesity, and other respiratory disease in people with sleep apnea.

Diagnosis

Testing for bendopnea is a straightforward matter of having a patient sit down and bend over at the waist. If they experience shortness of breath within 30 seconds of doing this, bendopnea is diagnosed.

Although bendopnea is a sign that heart failure is poorly controlled or getting worse, it is not regarded as a screening tool for heart failure. In other words, if you bend over and suddenly have trouble breathing, it is not a definitive sign you have heart failure. In fact, if you do have heart failure, you've likely experienced symptoms of the condition and have already been diagnosed.

Treatment

Since bendopnea is a symptom of heart failure, there is no targeted treatment for it. However, it may be alleviated if heart failure is well controlled.

This typically involves a combination of medications, including diuretics, which remove excess fluid from the body, restriction of salt from the diet (as sodium contributes to fluid retention), and, in advanced cases, implantation of a defibrillator or other procedures.

It's important to be aware there is no cure for heart failure, so targeted treatment and compliance are essential to preventing the condition from worsening and mitigating symptoms such as bendopnea.

Outcome

Bendopnea symptoms are considered a sign of advancing disease and are associated with a poor prognosis (outcome) in multiple studies.

Among the examples is a 2023 study of people with pulmonary hypertension that found bendopnea was part of a pattern that doubled the risk of death from right ventricular failure (a type of heart failure).

Because bendopnea is a sign of decompensating illness and potential complications, it's important to talk with your healthcare provider about the symptoms and ensure proper treatment.

Summary

Bendopnea occurs when you bend forward and experience difficulty breathing within 30 seconds. It is common among people living with heart failure and is a sign of worsening disease.

Bendopnea also occurs with other conditions, though it remains under study. These include obesity, sleep apnea, and other pulmonary diseases such as pulmonary hypertension.

Treatment depends on the underlying cause of the condition. It's associated with advancing disease and a poor prognosis, so be sure to have it evaluated by a healthcare provider.

12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Richard N. Fogoros, MD

By Richard N. Fogoros, MD
Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology.