The spontaneous onset of an asthma attack in a patient who does not suffer from bronchial asthma or obstructive pulmonary pathologies indicates acute left ventricular failure. Cardiac asthma is progressing in myocardial infarction, worsening of condition in cardiosclerosis, malformations and other diseases, accompanied by circulatory failure in a small circle.
The main causes of the disease
Causes are divided into two groups: cardiac and non-cardiac.
With severe changes in the work of the myocardium, asthma can occur with overeating, excessive fluid intake and eating before bedtime. In addition, the change in position from vertical to horizontal carries an increased load on the work of the left atrium and ventricle. To stop an asthma attack, it is worth establishing an etiological factor:
- exacerbation of an existing left ventricular failure;
- manifestation of ischemic heart disease (angina pectoris, myocardial infarction, sudden coronary death, vascular cardiosclerosis);
- ischemia of the coronary arteries in the postinfarction period (after 2–8 weeks);
- cardiomyopathy and acute myocarditis;
- malformations of heart valves, aneurysms;
- persistent arterial hypertension with high numbers that are difficult to treat, jumps in blood pressure as a result of an increase in the tone of the vascular wall and irregular intake of antihypertensive drugs;
- atrial fibrillation, extrasystoles, atrial flutter;
- pathological formations: floating thrombus, parietal blood clots, myxoma ;
- damage to the mitral valve after endocarditis;
- extracardiac pathologies: pneumonia, nephritis, hypervolemia , decreased intrathoracic pressure.
To understand the causal relationship between left ventricular failure and pulmonary edema, it is worth considering the pathogenesis of asthma. It consists of three main links:
- An increase in the volume of circulating blood. Due to the increase in blood flow into the capillaries of the lungs, the pressure on the inner layer of the blood vessels increases.
- Sweating of plasma in the alveoli of the lungs. The liquid part of the blood penetrates the alveolocapillary barrier into the alveoli (interstitial edema).
- Hypoxia (lack of oxygen). The area of the respiratory surface of the alveoli decreases.
Asthma begins at night, a person wakes up from a feeling of lack of air, shortness of breath is steadily increasing, there is a feeling of impending death.
The characteristic clinical symptoms of the disease are a spontaneous attack of shortness of breath and suffocation. Most often, they occur after increased physical exertion, doing household chores with the head tilted down, a stressful situation.
The patient takes a forced standing position with the torso tilted forward, leans on a table or window sill. At home and in a hospital, the recumbent takes a half-sitting position.
Signs of hypoxia are noticeable when examining the skin: pallor, the wings of the nose are divorced, the cyanotic nasolabial triangle, after a while it is replaced by a gray color. A manifestation of respiratory failure in asthma is the tension of the muscles of the shoulder girdle, smoothness of the supraclavicular fossae, an increase in the volume of the chest, retraction of the intercostal spaces, and swollen cervical veins.
For some, an asthma clinic is expected. The patient has 2–3 days before the attack symptoms-precursors:
- deterioration in general health;
- increased respiratory rate, short-term shortness of breath;
- choking at night and early morning.
On average, relief of an asthma attack occurs in the interval from 10-15 minutes to 2-3 hours. However, if the process is delayed and the condition becomes extremely difficult, it is imperative to seek medical help.
A medical examination and additional diagnostic methods will help to verify the diagnosis of “cardiac asthma”. When examining, percussion, palpation and auscultation, it is important to take into account the distinctive signs of the syndrome:
- nocturnal asthma attack;
- it is difficult to breathe in and out;
- inhalers do not help, organic nitrates are effective ( Nitroglycerin tablet sublingually );
- cold clammy sweat;
- the absence of wheezing on auscultation;
- fine bubbling wet rales are possible;
- decrease in pulse and pressure;
- the first asthma attacks in men and women are recorded at the age of 45-50 years;
- not burdened allergological anamnesis, test allergy tests negative.
Instrumental diagnostic techniques are required: electrocardiogram (ECG) and chest x-ray (CT) in direct projection. The ECG records arrhythmia, a decrease in the amplitude of the teeth and the ST interval. On the roentgenogram of the OGK in asthma, there is a decrease in the transparency of the lung tissue, signs of stagnation, indistinct outlines of the roots, the Curly line – linear darkening.
On the recommendation of related specialists in asthma, additional instrumental methods are performed:
- EchoCG (echocardiogram) visualizes defects, fractional ejection of blood, myocardial functioning;
- peak fluometry is performed to determine the vital volume of the lungs, the volume of forced expiration;
- coronary angiography for suspected angina pectoris and myocardial infarction.
Who to contact
If a severe form of an asthma attack with severe respiratory failure and cyanosis is recorded , an ambulance is called to the patient. People nearby should provide prehospital care.
With transient shortness of breath and precursors of cardiac asthma, an adult goes to the clinic to see a therapist, and then to a cardiologist. For non-cardiac reasons – a specialized specialist.
In case of repeated or newly diagnosed asthma in a child, it is necessary to consult a pediatrician, cardiologist, allergist to verify the diagnosis and carry out differential diagnostics.
What tests to take
There are no specific laboratory parameters for asthma, however, it is possible to track the disturbances of metabolic, hormonal and protein metabolism of the very pathology that caused this condition.
- clinical blood test;
- general urine analysis;
- a blood test for sugar and RW ( Wasserman reaction );
- blood chemistry;
- determination of troponins and creatine phosphokinase in myocardial infarction.
On the basis of the diagnostic techniques carried out, the final diagnosis of cardiac asthma is made.
Algorithm for providing prehospital care for cardiac asthma:
- Open the window.
- Put the patient on a chair.
- Call an ambulance.
- Measure pulse and blood pressure.
- Give nitroglycerin sublingually (under the tongue), which serves as an emergency medication . After 5 minutes, you can give another tablet, so the nitrate effect will continue .
To alleviate the condition, hot foot baths are done or a venous tourniquet is applied to the lower extremities. Carrying out pre-medical measures at the stage of waiting for emergency medical care is very important for the patient.
With asthma, a person is treated in a hospital, where oxygen therapy, medications are prescribed, and surgical intervention is considered. During hospitalization, emergency care for cardiac asthma is provided by a cardiologist, an intensive care physician and a nurse (placing droppers, parenterally injecting drugs), hygiene measures are performed by junior medical personnel.
Drug therapy includes:
- narcotic analgesics;
- cardiac glycosides;
- defoamers ;
Complex action of medicinal agents eliminates life-threatening condition, restores metabolism, myocardial work, rhythm, eliminates pulmonary edema.
It is possible to cure asthma with cardiac pathology by radically eliminating the cause: heart surgery, placement of a stent or cava filter. For non-cardiac causes of asthma, regular medication, examination, timely treatment of chronic diseases and lifestyle adjustments are important.
It is contraindicated to be treated with alternative methods in the acute period of asthma, as additional therapy is allowed after consultation with the attending specialist.
The prognosis directly depends on the etiological factor. Without proper therapy, it is unfavorable.
Prevention measures are aimed at timely treatment of diseases of the heart, kidneys, lungs. It is important to normalize the regime of work and rest, give up bad habits, follow a diet with a reduced content of sodium chloride.
Acute complications of asthma include alveolar pulmonary edema, it is a life-threatening, very severe and acute painful condition associated with the accumulation of interstitial fluid in the lung tissue and inside the alveoli.
Cardiac asthma is a symptom complex with increased blood volume in the lungs and overload of the pulmonary circulation. Requires emergency medical attention.
Spirography for bronchial asthma
Spirography is a diagnostic method by which the functionality of the lungs is assessed. The procedure is prescribed for pathologies of the respiratory system. Poor ecology, addictions, and the wrong way of life are considered to be the factors provoking diseases. One of the pathologies of the respiratory system is bronchial asthma. For an accurate diagnosis, spirography is performed, which allows you to register the patient’s breathing in the form of a graph.
The spirogram displays information about the work of the respiratory system. With the help of spirography, the patient’s condition is monitored. The procedure must be prescribed to athletes and employees who work under the influence of harmful conditions. Men and women from these categories are at risk. The sooner pathological changes in the lungs are detected, the lower the risk of serious complications.
Who is the examination indicated for?
Spirography is necessary if a person:
- smokes for a long period of time;
- suffering from bronchitis;
- subject to an allergic reaction.
A significant reason for the appointment of spirography is a predisposition to serious illnesses, the need to correct the therapeutic scheme. Among the indications for the use of spirography are:
- lingering cough;
- painful sensations in the chest;
- separation of mucus;
Asthma affects the bronchi. Due to spasm, the lumen narrows, the formation of a large amount of viscous sputum and disruptions that occur during gas exchange.
Spirography is considered a painless procedure. She has practically no contraindications. The existing restrictions include:
- toxicosis (in pregnant women);
- acute respiratory failure;
- myocardial infarction;
- arterial hypertension.
If the patient has at least one of the listed pathologies, the doctor prescribes supportive therapy for him. In this case, spirography is performed only after the patient’s general condition has stabilized.
The procedure is allowed for adults and children. Spirography is rarely prescribed for minors who are under 4 years old. This is due to the fact that babies at this age are restless. The data obtained during the procedure is unlikely to be reliable. Spirography is not recommended for the elderly. This can cause hyperventilation of the lungs.
Do you need preparation
In order for the procedure to give accurate information, it should be carried out in full accordance with the existing rules. Spirography is prescribed in the morning, preferably on an empty stomach. If necessary, the procedure is postponed. After eating, at least 1.5 hours should pass.
At the preparation stage , the patient should give up coffee, strong tea and cigarettes. He should have a good rest before the procedure. 24 hours before the spirography, the doctor cancels bronchodilators and antispasmodics. Ignoring medical advice will lead to negative consequences.
Spirography is performed in the functional diagnostics room. It should be supervised by a pulmonologist. Clinical research is carried out using a special device, it is called a spirograph. To obtain the necessary results, the patient exhales into the tube of this apparatus. The result of the work of the sensors is a graph. Treatment is prescribed after the doctor deciphers it. The values are transferred to the table.
Previously, water spirometers were used to carry out spirography. They consisted of a vessel with water and a cylinder. After exhalation, the cylinder rises and a graph appears on the tape. The effectiveness of the prescribed therapy directly depends on the degree, reversibility and variability of airway obstruction.
Spirography takes place according to the following algorithm:
- The patient takes a sitting position.
- A special clip is put on the nose.
- The mouthpiece is placed in the mouth.
- The patient breathes in the usual rhythm for several minutes.
- Then the patient breathes in and out at a slower pace.
The procedure takes a quarter of an hour. It is often combined with provocative tests.
Is it necessary to have a doctor
The appointment for spirography is prescribed by a doctor. Despite the safety, it can provoke unpleasant consequences. Therefore, the presence of a doctor is imperative. The procedure is most often carried out by a diagnostician or pulmonologist. If there are contraindications, the decision is made, focusing on the possible harm and potential benefits.
How often can
Spirography is a technique that must be included in a diagnostic examination. If the treatment is successful, the procedure is carried out once every 12 months. With an uncontrolled course of bronchial asthma, the time interval between sessions is reduced to six months. In the process of diagnostics, there is no harmful effect on the patient’s body.
Decoding the results
When interpreting the data, the individual characteristics of the patient are taken into account, among them, special attention is paid to height, weight, age and gender. The norms for patients belonging to different categories are different. If you ignore this fact, it is impossible to determine the exact cause of the ailment. The list of indicators obtained during decoding includes:
- tidal volume;
- vital capacity of the lungs;
- breathing rate;
- the volume of air entering the body within a minute.
They are detected in the first 5 minutes of spirography. To study the lung function in more detail, additional clinical studies are being conducted.
Provocative tests are necessary to assess bronchial reactivity. This test is optional, it is prescribed if:
- the etiology of the disease is unknown;
- there are pathologies of a chronic nature;
- the clinical picture is blurred.
The method can cause complications, so the patient must be under medical supervision.
In a healthy adult , the values of the indicators identified by spirography will be as follows:
- The tidal volume at rest is from 500 to 600 ml. In people who go in for sports, it is increased, this is considered the norm.
- Minute volume – the total volume of air passing through the respiratory system at a time when a person is calm.
- The vital capacity is 1500 ml.
- Forced expiratory volume – within one second, a patient who does not suffer from bronchial asthma should exhale at least 1050 ml. A decrease in this indicator indicates a deterioration in airway patency.
- Forced VC is equal to 90–95% of the normal lung volume.
- Tiffeneau’s index – it is calculated by dividing the volume of forced air by the vital capacity of the lungs. The norm is 70–75%.
During diagnostics, respiratory rate and air velocity are also taken into account.
Violations identified during the diagnosis indicate that the patient’s lungs are poorly functioning. This negatively affects the entire body. Spirography indicators for bronchial asthma are assessed based on individual characteristics. If deviations appear in an elderly patient, there is a possibility that they are the result of age-related changes. If negative manifestations occur in patients from other categories, suspicions of bronchial asthma are often confirmed.
Spirography and spirometry are unique diagnostic procedures. They cannot be replaced by other clinical research. These techniques are safe and simple. Assessment of the functionality of the pulmonary system is a mandatory step, without which a reliable result cannot be obtained .