Cardiac Asthma: Causes and Symptoms

Cardiac asthma is a by-product of heart failure. It is most common in patients of old age, and if not treated correctly or on time, could prove to be fatal.

Cardiac Asthma: 

Cardiac asthma is a condition caused by the reduced efficiency in the pumping of blood from the left side of the heart, which leads to pulmonary edema and asthma-like symptoms, such as shortness of breath, coughing, wheezing, etc.

Cardiac asthma can be chronic or acute, depending on the situation and onset of symptoms. It can be characterized as acute if there is a sudden onset of the symptoms followed by a severe attack. It is a medical emergency and can be fatal if not treated immediately or if the patient is not stabilized, usually through the use of medication. And it can be characterized as chronic if the patient has had several episodes over a period of time, and this is usually treated through surgery. 

Difference from Bronchial Asthma:

Even though the symptoms and signs of cardiac asthma greatly resemble bronchial asthma, it is not to be confused with it.

Bronchial asthma, or asthma in general, is a respiratory disorder in which the mucous membranes or bronchioles become inflamed, leading to coughing, shortness of breath, etc. Bronchial asthma is treated through inhalant or nasal corticosteroids, while cardiac asthma is treated by morphine, nitrates, or ACE inhibitors, depending on severity.

Also, patients of bronchial asthma usually feel the symptoms during the day, whereas patients of cardiac asthma usually feel the symptoms of their condition at night, most saying that they wake up after a few hours of falling asleep feeling like they are drowning or cannot breathe properly.

Bronchial asthma is also more prevalent or possible in children, while cardiac asthma usually inflicts itself on people of old age.

Pulmonary Oedema:

Pulmonary Oedema is a condition in which the lungs fill up with fluid. Basically, the tiny air sacs in the lungs, called alveoli, fill up with fluid instead of air, preventing the absorption of oxygen into the bloodstream.

Signs and Symptoms:

Every disease or infection comes with its signs and symptoms. The main signs and symptoms of cardiac asthma are:

•  Breathlessness
•  Difficulty in breathing
•  Bloody sputum
•  Wheezing or whistling sound produced while breathing.
•  Coughing
•  Greyish or bluish tinged lips and skin
•  Heaviness in chest
•  High blood pressure
•  All around tiredness of the body

Many of these symptoms are signs of respiratory diseases, such as bronchial asthma, as well, so a thorough check-up and inspection are required to make sure it is cardiac asthma because the treatments of these conditions differ.

Causes:

The fluid build-up that leads to cardiac asthma can be caused by:

1. A weak heart, because of repeated myocardial infarctions or other cardiac complications.
2. A leaky valve, causing improper blood flow between the atria and ventricles.
3. A congenital heart defect that may have been present since birth. 

Any of these problems can cause congestive heart failure.

Treatment:

The treatment for cardiac asthma is mainly dependent on the cause, but usually includes heart medication to control blood pressure, remove excess fluid from the lungs in addition to proper diet and daily exercises and activities specifically designed for the patients’ needs. If the cause is a leaky valve or congenital heart defect, medication may not be enough. Over the course of time, surgery might be required to cure the condition properly.

Accurate Diagnosis:

The key to the proper treatment of cardiac asthma is an accurate diagnosis. The difference between patients who wheeze because of acute heart failure from those who wheeze because of another disorder, such as pulmonary embolism, acute respiratory distress syndrome, asthma, pneumonia, etc. is not great, but it is there. Heart failure could be associated with any of these other conditions or may develop because of improper oxygenation of the blood.

Common medications:

 Patients who actually have cardiac asthma respond well to a combination of bronchodilators, supplementary oxygen, and heart failure treatments, such as the use of IV loop diuretics, morphine, nitrates, ACE inhibitors, digoxin, etc. Digoxin is usually for patients with acute heart failure who also have rapid atrial fibrillation. Doctors usually advise against the use of Beta-blockers because of potentially causing or worsening bronchospasm and the potential danger of weakening the heartbeat, which may make cardiac failure even worse.

 Corticosteroids:

The use of corticosteroids for a patient with cardiac asthma would depend on clinical trials of the drugs and the patient’s response to them. If they are effective, one of the main signs to look for is the reduction or complete stopping of the wheezing. 

Corticosteroids usually take a few hours until their effect can be completely observed. The treatment with a steroid may be helpful to patients who suffer from heart failure, and other respiratory disorders, including Chronic Obstructive Pulmonary Disorder (COPD), asthma, pneumonia, etc. In the past, intravenous aminophylline was commonly used to treat cardiac asthma, but this method has nowadays been replaced by the more modern methods stated above.

Management of cardiac asthma:

The management of cardiac asthma involves chiefly three therapeutic principles: 

• The control of perpetuating factors, such as treatment of pulmonary edema and control of breathlessness and coughing during night time.
• Taking action to lessen the inflow load, such as making the patient sit more, drawing blood through venesection, use of tourniquets on extremities, use of morphine, etc.
• Steps to reduce or remove the leftover blood on the left side of the heart through different methods such as digitalization, use of oxygen, aminophylline, etc.

Conclusion:

Cardiac asthma is a condition that may resemble other cardiac or respiratory disorders but is not the same as them. Misdiagnosed or mistreated, it can turn into quite a complication, putting the patient’s life in danger. That is why it’s proper treatment starts with an accurate diagnosis, and from there, doctors work on it. It’s by no means incurable; it just needs to be managed and monitored properly. For an accurate diagnosis and proper treatment, schedule an appointment with our specialists at South Florida Cardiovascular Specialists.