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Orthopnea and PND come under which class of NYHA

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heart failure AND NYHA

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NYHA functional classification orthopnea paroxysmal nocturnal dyspnea class III IV

Orthopnea and paroxysmal nocturnal dyspnea (PND) generally indicate NYHA Class III or IV heart failure, depending on whether symptoms occur only with activity or also at rest.
  • Class III: Marked limitation of physical activity. Comfortable at rest, but less-than-ordinary activity causes dyspnea/fatigue. Orthopnea or PND may be present, especially with congestion.
  • Class IV: Symptoms of heart failure at rest, often including severe orthopnea and/or PND; any activity worsens symptoms.
NYHA class is based on functional limitation, not on a single symptom alone. So orthopnea/PND with resting breathlessness favors Class IV.

Pulmonary edema can be acute or chronic?

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pulmonary edema AND chronic

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acute versus chronic pulmonary edema clinical features authoritative

Yes. Pulmonary edema may be acute or chronic.
  • Acute pulmonary edema: develops rapidly, over minutes to hours. It is an emergency, typically causing severe dyspnea, tachypnea, hypoxemia, pink frothy sputum, and diffuse crackles. Common causes include acute LV failure, myocardial ischemia/infarction, hypertensive emergency, acute valvular dysfunction, ARDS, and fluid overload.
  • Chronic pulmonary edema: develops gradually or is recurrent due to longstanding elevation of pulmonary venous pressure, most often from chronic left-sided heart failure or mitral valve disease. Symptoms include exertional dyspnea, orthopnea, PND, and chronic pulmonary vascular/interstitial radiographic changes.
So, orthopnea and PND suggest chronic pulmonary venous congestion, but a patient with chronic heart failure can suddenly develop acute pulmonary edema during decompensation. The NCBI clinical review similarly describes pulmonary edema as having either acute or gradual onset depending on its cause.
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