A syndrome that occurs suddenly with left ventricular heart failure is cardiac asthma. Stagnation of blood in the circulatory system provokes attacks of shortness of breath, turning into choking.
Since this syndrome can lead to death, in the first minutes of an attack, you need to urgently seek emergency help. Treatment should be comprehensive and carried out within a stationary regime. The cardiologist conducts the necessary examinations, collects anamnesis and, based on the data obtained, selects a treatment regimen.
Cardiac asthma: general information
Cardiac asthma is a serious condition of the body, which is characterized by sudden attacks of difficult breathing, up to and including suffocation. Such attacks happen more often at night, they last 3-5 minutes, but there are also longer ones, up to an hour. Cardiologists attribute this type of asthma to symptoms of acute heart failure in the pulmonary circulation (heart-lungs-heart).
At its core, each seizure is the ingress of fluid into the respiratory system. Stagnation of blood in the vessels of the lungs becomes the cause of difficulty breathing, loss of consciousness, tachycardia and other disorders. Without taking measures against the background of the syndrome, large-scale alveolar pulmonary edema develops, which leads to death.
On the surface, the differences between cardiac asthma and bronchial asthma are insignificant. Even a specialist at first glance will not be able to accurately determine the nature of the attack. But usually the root cause is known – a history of the disease. Bronchial, as a rule, begins with allergies and disorders of the respiratory system, and cardiac – with pathologies in the circulatory system and heart.
Difficulty in breathing is the main difference between cardiac asthma and bronchial asthma, which is characterized by difficulty in exhaling.
Signs of cardiac asthma must also be distinguished from seizure conditions, narrowing of the airways and larynx due to Quincke’s edema or compression of the mediastinal veins as a result of trauma.
The mechanism of development and causes of cardiac asthma
There are many causes of the syndrome. Cardiac asthma can be triggered by conditions such as:
- cardiomyopathy ;
- acute inflammation of the heart muscle;
- ischemic disease;
- stenosis (narrowing) of the mitral valve;
- thinning of the myocardium, heart attack;
- arrhythmia, tachycardia;
- excess blood in the system and, as a result, high blood pressure (hypertension);
- disorders of the left heart
- also provoke attacks of formation that block the blood flow – tumors, blood clots.
In addition to directly cardiac pathologies, allergic reactions, pneumonia, disorders of blood circulation in the brain and spinal cord – strokes (ischemic, hemorrhagic) can affect the deterioration of breathing.
The provoking factors are primarily:
- prolonged immobility;
- alcohol abuse;
- gestosis in pregnant women;
- drinking a lot of liquid and salt, especially in the evening (salt additionally retains water, this causes pulmonary edema and heart failure);
- constant stress, due to which the pressure rises, arrhythmia occurs, the heart stops working in its usual rhythm.
One way or another, in all cases, excessive load on the heart becomes the cause of cardiac asthma. The inability to breathe deeply can be triggered by excessive physical exertion, stress, or appears suddenly, for no particular reason, against the background of serious problems with the circulatory system.
Features of an attack
It is impossible to predict an attack in advance. It is developing rapidly. Patients with heart disease should be aware of the risk of cardiac asthma, what may initiate an attack, its early signs, and first aid guidelines. Usually an attack occurs when a person lies down: the position of the body changes, and with it the intensity of blood movement. Blood rushes to the lungs more actively and lingers there:
- the left atrium, which must receive the volume of blood from the lungs, does not cope with this task;
- the mitral valve between the atrium and the ventricle fails, and the direction of blood flow is disturbed;
- the left ventricle is unable to push blood into the systemic circulation.
The blood remains in the system of the small circle, congestion in the lungs increases. Breathing problems begin, blood pressure rises. The more serious the disturbances in the work of the heart, the less provoking physical or emotional stress is needed for an attack to begin.
The small circle of blood circulation in the human body looks like this: blood from the right ventricle passes through the lungs, is enriched with oxygen and returns to the left atrium. The mechanism of development of cardiac asthma is associated with the malfunctioning of the left side of the heart. If the left atrium, due to spasm, weakness, or for some other reason, is not able to absorb the volume of blood, then its stagnation occurs in the pulmonary veins.
A further pathogenesis of cardiac asthma is interstitial pulmonary edema due to the fact that the pressure in the vessels increases, and blood plasma enters the lungs through the capillaries. That is why cardiac asthma is considered a life-threatening condition: if you do not help the patient in time, the consequences can be irreversible, the patient will suffocate because of the fluid in the lungs.
A cardiac asthma attack usually begins suddenly. But the prerequisites may be gradually increasing problems shortly before the onset of the syndrome. Harbingers appear within 2-3 days: the patient may complain of breathing disorders, discomfort in the chest when changing the position of the body from vertical to horizontal.
Unaccustomed shortness of breath appears even after little exertion or stress. Signs can be of varying severity, and patients who have not previously had serious heart problems often do not pay attention to this, referring to severe fatigue or stress.
The asthma attack itself begins with a sudden lack of air. More often this happens during sleep, the patient wakes up from the fact that he cannot breathe. Clinical manifestations of cardiac asthma:
- each breath is difficult. The main symptom is noisy breathing and the absence of a feeling of fullness of the lungs with oxygen;
- breathing becomes more frequent, but does not bring relief, remaining superficial;
- the skin turns pale due to a lack of blood in the capillaries, noticeable cyanosis appears around the lips, the fingertips turn blue;
- a person takes a specific orthopnea position : he sits down, straightens and slightly tilts the upper body forward, bends his neck. If there is nowhere to sit, the patient rests his hands on the table, headboard, wall. Thus, he instinctively reduces the load on the respiratory system so that more oxygen flows into the lungs;
- the pulse quickens, the heart beats in an unusual rhythm: too fast or inconsistently (arrhythmia);
- veins in the neck swell due to a violation of the outflow of blood from the upper body;
- after a while (10-15 minutes) a dry cough appears, which does not bring relief. The wheezing is moist and well audible.
These symptoms of cardiac asthma cause panic attacks that make the condition worse. Fear appears due to oxygen starvation of the brain, it forces the atrial muscle to contract even more, attempts to cough up do not allow oxygen to enter the lungs. Therefore, patients during an attack need to try to calm down and not succumb to fear.
Complications of cardiac asthma
The main complication of cardiac asthma with prolonged stagnation of blood in the lungs is extensive edema:
- when coughing, sputum begins to separate in small quantities;
- the skin acquires a grayish tint, profuse cold sweat appears due to a violation of thermoregulation;
- a condition that threatens the patient’s life is accompanied by severe arrhythmia, tachycardia, pink foam from the mouth. The skin turns blue due to prolonged lack of air. The patient cannot breathe.
Therefore, even at the first signs of cardiac asthma, you should immediately call a doctor so as not to bring the alveoli to fill with liquid and suffocate.
When listening with a stethoscope, the doctor notices wheezing in the lower part of the lungs, specific heart murmurs and excessive tension of those muscles of the back and intercostal spaces that normally do not participate in the breathing process.
To confirm the diagnosis of cardiac asthma, after stopping the attack, the doctor prescribes:
- radiography of the lungs;
- EchoCG .
The results of these examinations are sufficient to diagnose cardiac asthma. Additionally, you can take a blood test. If the attack occurred on the basis of heart failure, then the results will show the consequences of serious disturbances in the work of the circulatory system.
First aid for an attack
The first point of the algorithm of actions is to call an ambulance with a clear, quick and understandable description of the symptoms of the patient’s condition. Then, measures for the provision of emergency care in cardiac asthma should be aimed at facilitating breathing and restoring the work of the heart muscle.
The outcome of an attack largely depends on those people who are close to the patient: in a serious condition, the patient can rarely get to the phone, call a doctor, open a window, not to mention other measures. People around you must act quickly, clearly and without panic:
- The first point of first aid for cardiac asthma is to help the patient sit up. Lower your legs to the floor, organize support under your back (pillows, chair back). In this position, the air penetrates better into the lungs and the movement of blood through the large circle of blood circulation to the lower extremities is activated.
- Free the patient’s chest from tight clothing.
- The supply of fresh air will help the patient to panic less. Therefore, an open window will be the best option. Sometimes an oxygen cylinder may be at hand – in this case, it will be very useful.
- After 10 minutes, place the patient’s feet in a warm place: a basin of water, a heating pad, a blanket. Dry or moist heat will increase blood flow to the lower half of the body and outflow from the upper half.
- At high pressure, drugs with a vasodilator effect are used.
- If the pressure is high, and there are no drugs at hand, a tourniquet is applied to the thigh over the clothes, 15 cm from the groin. They hold such a tourniquet for no more than 30 minutes. Remove as soon as the pressure has stabilized. The tourniquet reduces the load on the upper half of the body, not allowing blood to pass from the systemic circulation to the heart and further to the small circle. The tourniquet can only be applied by a person with the necessary skills. Incorrect application leads to impaired circulation and innervation of the limb.
- Inhalation of ethyl alcohol vapor helps to avoid pulmonary edema. It is enough to apply it on cotton wool, cloth or gauze and keep it near the patient’s face.
The ambulance team provides the patient with an oxygen mask, injections of antipsychotics intramuscularly to stop panic attacks and strong analgesics to eliminate heart pain. Bloodletting is one way to lower your blood pressure .
In difficult cases, drugs are added to reduce fluid levels in the body (diuretics). Drugs from the glycoside group help relieve spasms of the heart muscle and improve blood flow. Extra carried pacing to align the rhythm.
Treating cardiac asthma
Immediately after the arrival of the ambulance team and the relief of the attack, the patient either remains on outpatient treatment or is sent to the hospital. The decision is made by the doctors together with the patient. It is better to agree to hospitalization, because in a hospital all examinations will be carried out faster than in a polyclinic. In any case, cardiac asthma cannot be ignored. The attack may recur, when and where it will happen is unknown.
Treatment of cardiac asthma is complex. First, the necessary tests and examinations are carried out. A cardiologist will assess the condition of the heart and lungs after an attack and choose a treatment strategy.
Usually, medications are indicated for cardiac asthma that:
- eliminate edema, remove excess fluid from the body;
- strengthen the heart muscle;
- restore heart rhythm and normalize blood pressure.
Features of the diet
In addition to medications, a strict diet is prescribed. The diet should be varied, food is prepared with the maximum preservation of nutrients, vitamins and minerals. The general rules of the diet are as follows:
- almost complete rejection of salt;
- food should be light, not to linger in the body: soups, chopped and pyurirovannye products, steamed and cooked vegetables in a double boiler;
- as little as possible cooked fats. Boiled and steamed dishes, completely without oil, will be ideal;
- porridge in water and milk;
- light dairy products;
- boiled eggs, fresh vegetables and fruits;
- the drinking regime is moderate. Immediately after an attack, it is better to limit fluid intake (no more than 1.5 liters per day). In the future, you can leave the standard rate of 2 liters per day.
Do not overeat or get drunk before bed. It should take 3 hours from dinner to bed.
In the first place, further treatment focuses on eliminating the cause that caused the asthma attack. If the heart failure was caused by a more serious illness, the doctor will prescribe specific medications to treat it and continue monitoring. After examination, it may turn out that the patient needs heart surgery. Do not give up this chance for a fulfilling life.
The outcome of an attack of cardiac asthma depends on the causes of its occurrence and on how seriously the patient himself takes his condition. Compliance with all the recommendations of a cardiologist and taking all prescribed medications in some cases is a sufficient measure to prevent the attack from recurring. But still, this syndrome does not occur without a serious illness, which requires constant monitoring, changes in lifestyle and habits.
Even with the general excellent condition of the patient, the prognosis remains poor. It is believed that an attack can begin at any time. A condition that threatens sudden death requires careful monitoring and careful attitude of the patient to his health.
Prevention of cardiac asthma
A patient with any heart disease should be aware of the risk of cardiac asthma and take measures to prevent it.
First of all, you need to monitor the state of the heart. Regular observation by a cardiologist and the fulfillment of all his prescriptions will help to identify violations in the early stages. Even if the external manifestations of heart disease have not yet occurred, healthy people should undergo a medical examination every three years and check the work of the heart muscle.
A healthy lifestyle will keep you healthy:
- regular eight-hour sleep;
- walking long distances;
- physical activity in accordance with the state of the body;
- rejection of bad habits.