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Paroxysmal nocturnal dyspnea is a sudden onset of shortness of breath that occurs during sleep and typically wakes the person from their sleep. This condition is commonly associated with left-sided heart failure. In left-sided heart failure, the heart is unable to effectively pump blood to the body, leading to a backup of fluid in the lungs. As a result, when a person lies down, the fluid redistribution can worsen pulmonary congestion, leading to difficulty breathing and symptoms that can include paroxysmal nocturnal dyspnea.

In contrast, right-sided heart failure primarily causes fluid accumulation in the body tissues and does not typically induce this type of nighttime breathing difficulty. Conditions like stable angina and myocardial infarction are related to coronary artery disease and may also present with shortness of breath, but they do not characteristically manifest as paroxysmal nocturnal dyspnea. This symptom is a hallmark of the pulmonary congestion associated with left-sided heart failure, highlighting the critical link between the function of the heart's left side and the pulmonary circulation.