The symptoms and treatment of cardiac asthma
The content of the article:
What is cardiac asthma?
Cardiac asthma is a condition of acute failure of the left chamber of the heart that is characterized by attacks of breathlessness, suffocation and requires emergency medical care, as even the precursors of asthma can lead to death. Failure is expressed in the feeling of lack of oxygen, therefore the person begins to cough, to wheeze, his face becomes cyanotic, increases diastolic pressure, there is a fear of death. The attack requires the application of urgent measures to help the patient with taking nitroglycerin, diuretics, oxygen therapy and other urgent actions.
Cardiac asthma is not an independent disease. So-called clinical syndrome that manifests certain characteristics. Cardiologists consider cardiac asthma, as the most severe manifestation of acute heart failure, which complicates other existing human cardiovascular disease. During the attack affects not only the circulatory system but also the respiratory system. Cardiac asthma often characterizes the onset of fulminant alveolar pulmonary edema, which leads to the death of a person.
The causes of cardiac asthmaThe causes of cardiac asthma may be hiding in the defeat most to the heart muscle, and 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 in the background of such forms of ischemic heart disease: unstable angina and acute myocardial infarction.
- Perhaps the development of cardiac asthma in the postinfarction period and on the background of atherosclerotic cardiosclerosis.
- Such irregularities in the heart as postpartum cardiomyopathy, acute myocarditis is able to provoke the development of an attack of cardiac asthma. This can be attributed to an aneurysm of the heart.
Hypertension with high pressure jumps and excessive tonus of the myocardium of the left ventricle,atrial fibrillation, atrial flutter represent a potential threat in terms of the development of this cardiac syndrome.
- The factors provocateurs include valvular heart disease (mitral and aortic), as they impede the normal flow of blood. Also blood circulation is disturbed on the background of existing vnutriepreserdna clot in the presence of tumor within the cavity of the heart called a myxoma.
Among the lung diseases that are the cause of cardiac asthma, isolated pneumonia, a kidney disease is acute glomerulonephritis. The danger in this respect also represent any marked disorders of cerebral circulation.
- May provoke an attack, excessive exercise, severe emotional shock and stress, hypervolemia in the background carrying a child, with fevers, intravenous administration of large volumes of liquid, and its delay in the body.
- The danger in the plan of attack of cardiac asthma is the excessive consumption of food prior to sleep, the same applies to liquids. Against a background of existing heart disorders asthma can develop even when a quick and sharp transition from vertical to horizontal position.
If we turn to the pathogenesis of cardiac asthma, it is based on the fact that the left half of the heart cannot cope with their workload. This leads to the fact that the veins and capillaries of the lungs filled with too much blood, dramatically increases the hydrostatic pressure in the pulmonary circulation. Due to excessive pressure inside the blood vessels through capillary walls and leaking plasma entering the lung tissue. This leads to the development of interstitial pulmonary edema, which will certainly affect their normal ventilation and in the process of gas exchange between the blood and alveoli.
One of the pathogenetic factors of cardiac asthma include increased blood flow, filling vessels, such as during pregnancy or when raising the body temperature. In this case, increasing the venous current of blood flowing to the heart, accompanied by obstruction of the outflow of blood filled the lungs to the left heart. Therefore, patients with chronic heart failure it is important to avoid physical exertion. To provoke cardiac asthma in these patients can also the horizontal position of the body and intravenous injection of large volume of liquids.
To influence the severity and extent of symptoms of asthma is capable of disorders in the nervous system, as it is responsible for the breath control. So, increased heart rate, hyperhidrosis, coldof limbs is due to excessive stimulation of the respiratory centre.
The symptoms of cardiac asthma
The typical symptoms of cardiac asthma begins most often at night. Waking up from suffocation, the patient may panic because of the fear of death. In most cases there is a characteristic for the disease is frequent and deep breathing with paroxysmal dry cough. Patient sits up in bed, dangling his legs, or stands up and walks to the open window. The symptoms of cardiac asthma include skin pallor, cyanosis of the face, nasolabial triangle, the fingertips, a drop of sweat.
The doctor on examination the patient has not observed the pathological noises in the lungs during breathing. Only if the symptoms of cardiac asthma are the first signs of pulmonary edema, you will hear hard breathing, accompanied by moist (finely) wheezing in the lower lung.
In some patients cardiac asthma occurs with bronchoconstriction reflex character, cause wheezes when listening. This can cause difficulty for the physician in the diagnosis, as similar symptoms were observed in bronchial asthma.
Other symptoms of cardiac asthma include:
- On average, 2-3 days before the attack, the patient may experience symptoms-signs. There is a feeling of pressure in the chest, shortness of breath that occurs even with little physical effort.
- Manifest attacks more often at night as during the holidays adrenergic regulation weakens, and the blood in greater volume enters the pulmonary circulation. If the attack begins in the afternoon, he often preceded by nervous or physical tension.
- If the attack happens at night, then the person abruptly wakes up as he begins to choke. Shortness of breath increases, passes into suffocation. At the same time there is a dry cough. Transparent sputum departs a little later.
- Patient to lie not, as his health is deteriorating from it. Man either stands up or sits up in bed, taking his legs down, to reduce the severity of shortness of breath. This symptom is called orthopnea (shortness of breath in a horizontal position).
- To say the person is difficult, there are problems with breathing.
- The patient becomes overly excited, as growing panic and fear imminent death.
- Nasolabial triangle and phalanges turn blue. Quickens the heartbeat, the pressure rises.
- An attack may last for a few hours and can be completed infor a few minutes. The frequency of exacerbations will depend on the reasons that caused her asthma. For example, on the background of mitral stenosis attacks happen infrequently, because the pulmonary arterioles constrict reflex that prevents blood to stagnate in the venous line and in the capillaries.
- If the patient develops right ventricular failure, asthma may disappear completely.
- In some cases, on the background of cardiac asthma can sometimes be a reflex spasm of the bronchi. This makes diagnosis more difficult because the clinical picture resembles the symptoms of asthma.
- If the attack be protracted and runs hard, nasolabial triangle becomes gray in color, the patient breaks a cold sweat, neck veins increase in volume, filled with blood. The pulse weakens, almost not palpable, the pressure drops. The person becomes completely exhausted.
- The heavier the attack, the higher the risk that will join the alveolar pulmonary edema. His demonstration indicates Department abundant sputum with foam and blood, heavy, ortopnoe.
Diagnosis of cardiac asthmaDiagnosis of cardiac asthma must be particularly careful, as it is important to distinguish this syndrome from bronchial asthma, uremia, stenosis of the larynx, hysterical seizure and mediastinal syndrome. The doctor, in addition to careful questioning and examination, should study the history of the patient, send him to the passage of ECG and chest x-ray.
During the attack listen for heart sounds is difficult enough, but to determine their muted can. Also hear abnormal heart rhythm (gallop rhythm), the second tone accentuated over the pulmonary trunk. The pulse during the attack is weak, sometimes filiform. The pressure first increases, and then decreases. At the same time in a single or light listened scattered dry rales. Perhaps the emergence of single moist rales.
X-ray examination of the chest to determine the presence of signs of venous stasis in the pulmonary circulation, the pulmonary fields are less transparent, the roots of the lungs expanded, their possible necrosis. That there is interstitial edema, will testify line curly.
The electrocardiogram will reveal arrhythmia, coronary insufficiency, reduction of amplitude of teeth.
To expose the differentialdiagnosed with bronchial asthma, you need to first pay attention to when the first symptoms of the disease. So, cardiac asthma is most often seen in the elderly. In this patient, is no allergic history, no diseases of the respiratory system, but there is cardiovascular disease.
Emergency first aid in case of cardiac asthma
Although the attack may pass on their own, there is a high risk of developing pulmonary oedema, so urgent first aid in case of cardiac asthma should be provided to the person on the spot. It is important as quickly as possible to inhibit the excessive neuroreflex activity of the respiratory center, which is in the excited state, relieve emotional stress, enhance the outflow of blood from the pulmonary circulation.
Naturally, the first place you need to call an ambulance, as this condition poses a direct threat to the life of the patient.
Until doctors arrived to a call place, should provide the individual with maximum comfort. For starters, he needs to take a vertical position, it is better to put him in a comfortable chair. The legs should be lowered down. If possible, you need the lower limbs to put in hot water. On the throat and on the body should be free of objects that hinder breathing. For this you need to loosen the belt, remove the scarf and the bandages from her neck to undo the collar. Windows need to be open as widely as possible to the room did fresh air. If it's not too cold, then the patient can sit near the window.
Alleviate the condition may Nitroglycerin. For this you need to put under the tongue 2-3 tablets of the drug, or there to pour 5-6 drops of this drug. Repeat administration of Nitroglycerin is allowed after 10 minutes. You can replace the Nitroglycerin one tablet Corinfar. In parallel, you need to control blood pressure. If neither one nor the other means were not at hand, then you can replace them with Validol.
Another effective measure of first aid during a heart attack – is the imposition of venous tourniquet. This should be done after 10 minutes after the person has accepted vertical position. Replace the harness can nylon stockings, ACE bandages any bandage. Tourniquets applied to both legs and hands. Distance from the groin to place a tourniquet should be 15 cm on the foot and the hand 10 cm from the shoulder. 15 minutes later the harness with one-hand stand on another. Harnesses need to ensure that the blood stayed in the extremities, and the load on the heart was less. Thus it is possible to reduce the risk of interstitial pulmonary edema.
Of course,the sooner the person hospitalitynet, the better. This is done even if the attack failed to arrest. In the future, will definitely need treatment for the reason that this attack was provoked.
Treatment of cardiac asthmaTreatment of cardiac asthma are intended to as soon as possible to stop the seizure.
Medical care is reduced to the following activities:
- Receiving narcotic analgesics, e.g. Morphine or Pantopon. Should be combined with Atropine. Drugs used to correct severe shortness of breath and severe pain.
- If you have tachycardia, the patient needs to prescribe Suprastin or Pipolfen.
- On the background of the impairment of respiratory function, in the presence of a bronchial spasm, and if there is brain edema, chronic pulmonary heart, the narcotic analgesics will be replaced by Droperidol.
- Makes it quicker to unload the pulmonary circulation against a high pressure and venous congestion method such as bloodletting. The amount of blood it should not exceed 500 ml.
- Health workers can also apply tourniquets. The time of exposure to the extremities does not exceed half an hour. It is important that the harness below the palpated pulse.
- A good helping of pure oxygen, passed through ethyl alcohol. They are implemented by means of masks or nasal catheters and reduce the swelling of lung tissue.
- On the background of pulmonary edema, the patient urgently needed transition to a ventilator.
- To reduce blood pressure you need to give the patient a diuretic drug e.g. Lasix or Furosemide, as well as specialized tools to reduce pressure.
- Cardiac glycosides such as Digoxin and Strophanthin administered intravenously when an attack of cardiac asthma is almost always.
Aminophylline is prescribed for bronchial and cardiac asthma, on the background of mitral stenosis.
- Defibrillation is recommended at infringement of heart rhythm activity.
So, to cure cardiac asthma, then remove the acute attack and to prevent the development of alveolar edema of the lungs. Further therapy is conducted in a hospital environment and should be directed at eliminating the underlying disease. The only way the attack could be prevented in the future.
Whatfor the forecast, it primarily is determined by what caused the development of cardiac asthma. It is worth noting that the vast majority of cases, cardiac asthma has the prognosis is not favorable. Although competent treatment leading to illness and compliance with all regulations doctor allows a person to remain operational for several years.