Cardiac Asthma - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Symptoms and treatment of cardiac asthma

Content:

• Causes of cardiac asthma
• Symptoms of cardiac asthma
• Diagnosis of cardiac asthma
• Emergency first aid for cardiac asthma
• Treating cardiac asthma

What is cardiac asthma?

Cardiac asthma is a condition of acute failure of the left part of the heart, which is characterized by attacks of shortness of breath, suffocation and requires emergency medical care, since even precursors of asthma can be fatal. Insufficiency in a feeling of lack of oxygen is expressed, and therefore a person begins to cough, wheeze, his face becomes cyanotic, diastolic pressure increases, and fear of death appears. An attack requires the use of urgent measures to help the patient with taking nitroglycerin, diuretics, oxygen therapy and other urgent actions.

Cardiac asthma is not an independent disease. This is the name of the clinical syndrome, which is manifested by certain signs. Cardiologists consider cardiac asthma as the most severe manifestation of acute heart failure, which complicates other cardiovascular pathologies in humans. During an attack, not only the circulatory system suffers, but also the respiratory system. Often, cardiac asthma is characterized by the onset of fulminant alveolar pulmonary edema, which leads to the death of a person.

Causes of cardiac asthma

The causes of cardiac asthma can be hidden both in the defeat of the heart muscle itself, and in diseases not related to cardiology.

There are the following etiological factors leading to the development of this pathological condition:

• Left ventricular failure in the acute stage can lead to the development of cardiac asthma.
• Often this clinical syndrome develops against the background of such forms of coronary heart disease as: unstable angina pectoris and acute myocardial infarction.
• Perhaps the development of cardiac asthma in the postinfarction period and against the background of atherosclerotic cardiosclerosis.

• Such disorders in the work of the heart as postpartum cardiomyopathy, acute myocarditis can provoke the development of an attack of cardiac asthma. This also includes heart aneurysms.
• Arterial hypertension with high pressure surges and excessive tone of the left ventricular myocardium, atrial fibrillation, atrial flutter pose a potential threat to the development of this cardiac syndrome.
• Factors-provocateurs include heart defects (mitral and aortic), as they impede normal blood flow. Also, blood circulation is impaired against the background of an existing intra-atrial thrombus, in the presence of a tumor inside the heart cavity, which is called myxoma.
• Among the lung diseases, which are the cause of the development of cardiac asthma, pneumonia is distinguished, and among kidney diseases - acute glomerulonephritis. Any pronounced disorders of cerebral circulation are also dangerous in this regard.

• Excessive physical exertion, severe emotional shock and stress, hypervolemia against the background of bearing a child, with feverish conditions, with intravenous administration of a large volume of fluid and its retention in the body can provoke an attack.
• The danger in terms of the development of an attack of cardiac asthma is the excessive consumption of food before bedtime, the same applies to fluid. Against the background of existing heart disorders, asthma can develop even with a rapid and abrupt transition from a vertical to a horizontal position.

If we turn to the pathogenesis of cardiac asthma, then it is based on the fact that the left parts of the heart cannot cope with the load imposed on them. This leads to the fact that the veins and capillaries of the lungs are filled with too much blood, the hydrostatic pressure in the pulmonary circulation increases sharply. Against the background of excessive pressure inside the vessels, plasma seeps through the walls of the capillaries, entering the lung tissue. This leads to the development of interstitial pulmonary edema, which will certainly affect their normal ventilation and the process of gas exchange between blood and alveoli.

One of the pathogenic factors of cardiac asthma is an increase in the flow of blood that fills the vessels, for example, during pregnancy or when the body temperature rises. In this case, the increasing venous blood flow to the heart is accompanied by a difficulty in its outflow from the blood-filled lungs to the left heart. That is why it is important for patients with chronic heart failure to avoid physical activity. Cardiac asthma in such patients can also be provoked by horizontal position of the body and intravenous administration of large volumes of fluids.

Disturbances in the nervous system can influence the severity and degree of manifestation of asthma symptoms, since it is she who is responsible for controlling breathing. So, increased heartbeat, hyperhidrosis, cold extremities are associated with excessive excitation of the respiratory center.

Symptoms of cardiac asthma

The characteristic symptoms of cardiac asthma begin most often at night. Waking up from suffocation, patients may panic due to fear of death. In most cases, frequent and deep enough breathing, characteristic of the disease, is noted with paroxysmal dry cough. The patient sits up in bed with his legs dangling, or gets up and walks to an open window. Symptoms of cardiac asthma also include pallor of the skin, cyanosis of the face, nasolabial triangle, fingertips, and drops of sweat.

When examining a patient, the doctor does not note pathological noises in the lungs during breathing. Only if the symptoms of cardiac asthma are the first harbingers of pulmonary edema, hard breathing is heard, accompanied by moist (fine bubble) wheezing in the lower parts of the lungs.

In some patients, cardiac asthma proceeds with reflex bronchospasm, which causes dry wheezing when listening. This can cause difficulty for the doctor when making a diagnosis, since similar symptoms are observed in bronchial asthma.

Other symptoms of cardiac asthma include:

• On average, 2-3 days before the onset of an attack, the patient may experience precursor symptoms. There is a feeling of pressure in the chest, shortness of breath, which occurs even with minor physical efforts.
• Seizures are manifested more often at night, since during rest, adrenergic regulation weakens, and blood flows in a larger volume to the pulmonary circulation. If the attack begins in the afternoon, then it is most often preceded by nervous or physical stress.
• If an attack occurs at night, then the person wakes up abruptly, as he begins to choke. Shortness of breath increases, turns into choking. At the same time, a dry cough appears. Transparent sputum leaves a little later.
• The patient is not able to lie down, as his health worsens from this. The person either stands up or sits down in bed with their legs down to reduce the severity of shortness of breath. This symptom is called orthopnea (dyspnea when lying down).
• It is difficult for a person to speak, breathing problems are observed.
• The patient becomes overly agitated, as the panic fear of imminent death grows.
• The nasolabial triangle and phalanges of the fingers turn blue. Heart rate increases, blood pressure rises.
• The attack can last for several hours, or it can be completed in a few minutes. The frequency of flare-ups will depend on the underlying cause of the cardiac asthma. For example, against the background of mitral stenosis, seizures occur infrequently, since the pulmonary arterioles reflexively narrow, which prevents blood from stagnating in the venous bed and in the capillaries.
• If the patient develops right ventricular failure, then asthma may completely disappear.
• In some cases, against the background of cardiac asthma, a reflex spasm of the bronchi occurs. This makes the diagnosis of the disease more difficult, since the clinical picture resembles the symptoms of bronchial asthma.
• If the attack has a protracted nature and is difficult, then the nasolabial triangle becomes gray, the patient breaks through with cold sweat, the neck veins increase in volume, filling with blood. The pulse weakens, practically cannot be felt, the pressure drops. The person becomes completely exhausted.
• The more severe the attack, the higher the risk that alveolar pulmonary edema will join. Its manifestation is indicated by the separation of copious sputum with foam and blood, severe orthopnea.

Diagnosis of cardiac asthma

Diagnosis of cardiac asthma should be especially careful, since it is important to distinguish this syndrome from bronchial asthma, from uremia, laryngeal stenosis, hysterical seizure and mediastinal syndrome. The doctor, in addition to a thorough questioning and examination, should study the patient's history, send him for an ECG and a chest x-ray.

During an attack, listening to heart sounds is quite difficult, but you can determine their muffledness. Violations of the heart rhythm (gallop rhythm) are also heard, the second tone is accentuated over the pulmonary trunk. The pulse during an attack is weak, sometimes threadlike. The pressure first rises and then falls. At the same time, single or scattered dry rales are heard in the lungs. The appearance of single moist wheezing is possible.

X-ray examination of the chest allows you to determine the presence of signs of stagnation of venous blood in the pulmonary circulation, the pulmonary fields will be less transparent, the roots of the lungs are expanded, their necrosis is possible. The fact that there is interstitial edema will be evidenced by the Curly line.

An electrocardiogram will reveal arrhythmia, coronary insufficiency, a decrease in the amplitude of the teeth.

To make a differential diagnosis with bronchial asthma, it is necessary first of all to pay attention to when the first symptoms of the disease appeared. So, cardiac asthma most often manifests itself in old age. At the same time, the patient has no allergic history, no diseases of the respiratory system, but there is a cardiovascular pathology.

Emergency first aid for cardiac asthma

Although an attack can resolve on its own, there is a high risk of developing pulmonary edema, therefore, emergency first aid for cardiac asthma should be provided to the person on the spot. It is important to suppress as soon as possible the excessive activity of the neuroreflex respiratory center, which is in an excited state, to relieve the emotional stress, and to increase the outflow of blood from the pulmonary circulation.

Naturally, first of all, you need to call an ambulance, since such a condition poses a direct threat to the patient's life.

Until the doctors arrive at the place of the call, the person should be provided with maximum peace. To begin with, he must take an upright position, for this it is best to sit him in a comfortable chair. Legs should be down. If there is such an opportunity, then you need to put the lower limbs in hot water. There should be no objects on the throat and on the body that impede breathing. To do this, you need to relax the belt, remove the scarf and bandage from the neck, unfasten the collar. The windows need to be thrown open as wide as possible so that fresh air can enter the room. If it is not too cold, then the patient can be seated near the window.

Nitroglycerin can relieve the condition. To do this, put 2-3 tablets of the drug under the tongue, or pour 5-6 drops of this drug there. It is allowed to repeat taking Nitroglycerin after 10 minutes. You can replace Nitroglycerin with one Corinfar tablet. In parallel, you need to control blood pressure. If neither one nor the other means was at hand, then you can replace them with Validol.

Another effective first aid measure for a heart attack is the application of a venous tourniquet. This should be done 10 minutes after the person has taken an upright position. Nylon tights, elastic bandage, any bandage can replace the tourniquet. Tourniquets are applied to both legs and arm. The distance from the groin fold to the place where the tourniquet is applied should be 15 cm on the leg, and on the arm - 10 cm from the shoulder. After 15 minutes, the tourniquet is transferred from one hand to the other. The tourniquets are needed so that the blood remains in the extremities, and the load on the heart is less. This can reduce the risk of interstitial pulmonary edema.

Naturally, the earlier a person is hospitalized, the better. This is done even if the attack was stopped. In the future, treatment of the cause that provoked this attack will be required.

Treating cardiac asthma

Treatment for cardiac asthma is aimed at stopping the attack as quickly as possible.

Medical help is reduced to the following activities:

• Taking narcotic analgesics such as Morphine or Pantopon. They should be combined with Atropine. The drugs are used to eliminate severe shortness of breath and severe pain.
• If there is tachycardia, then the patient should be prescribed Suprastin or Pipolfen.
• Against the background of impaired respiratory function, in the presence of bronchial spasm, and also if there is cerebral edema, or chronic pulmonary heart disease, then narcotic analgesics will be replaced with Droperidol.
• Allows you to quickly relieve the pulmonary circulation against the background of high pressure and venous stasis, such a method as bloodletting. The amount of blood should not exceed 500 ml.
• Medical professionals can also apply tourniquets. Their exposure time on the limbs should not exceed half an hour. In this case, it is important that the pulse is felt below the tourniquet.
• Oxygen inhalation, passed through ethyl alcohol, helps well. They are carried out using masks or nasal catheters and can reduce the swelling of the lung tissue.
• Against the background of pulmonary edema, the patient urgently needs to switch to artificial ventilation.
• To reduce blood pressure, you need to give the patient a diuretic, for example, Lasix or Furosemide, as well as specialized drugs to lower the pressure.
• Cardiac glycosides such as Digoxin and Strofantin are administered intravenously during an attack of cardiac asthma almost always.
• Euphyllin is prescribed for bronchial and cardiac asthma, against the background of mitral stenosis.
• Defibrillation is recommended for cardiac arrhythmias.

So, to cure cardiac asthma means to relieve an acute attack and prevent the development of alveolar pulmonary edema. Further therapy is carried out in a hospital setting and should be aimed at eliminating the underlying disease. This is the only way to prevent an attack in the future.

As for the prognosis, it is primarily determined by what is the cause of the development of cardiac asthma. It should be noted that in the overwhelming majority of cases, cardiac asthma has an unfavorable prognosis. Although competent treatment of the leading disease and adherence to all the doctor's prescriptions allows a person to remain productive for several years.

The author of the article: Molchanov Sergey Nikolaevich | Cardiologist

Education: Diploma in "Cardiology" received at the PMGMU. I. M. Sechenov (2015). Here I completed my postgraduate studies and received a diploma "Cardiologist".