Instrumental methods for diagnosing bronchial obstructive syndrome. Cardiac asthma

An X-ray examination of the chest evaluates the configuration and size of the heart, usually diagnoses the cause of the sudden onset of dyspnea – spontaneous pneumothorax, severe pneumonia, cardiac pulmonary edema (for example, a butterfly symptom). With slowly progressive dyspnea, lung cancer or COPD can be verified radiologically. In the period of a severe attack of BF, in addition to the signs of the underlying disease, acute EL is also determined (increased airiness of the lung tissue, low standing of the dome of the diaphragm, horizontal position of the ribs). ECG – in the chronic course of biofeedback it usually reveals an overload of the right heart, incomplete blockade of the right leg of the bundle of His. Echocardiography helps to visualize heart defects, signs of PH and to assess the condition of the myocardium (hypokinesia zone) and LVEF. Typically, the differential diagnosis of bronchial obstructive syndrome is based on distinguishing AD from cardiac asthma, COPD, bronchogenic cancer, tracheobronchial dyskinesia (TBD) and aspiration syndrome. In this case, it is more correct to first search for the cause of BFB among heart diseases. If there are none, then a lung examination is necessary. We offer the following differential diagnosis of biofeedback. Cardiac asthma (CA) is an OLZH attack with severe paroxysmal cardiac dyspnea or suffocation (attacks of unproductive cough may be equivalent). In cardiac asthma, congestion in the lungs leads to the development of congestive bronchitis with bronchial obstruction and interstidial pulmonary edema with the formation of LV weakness. These patients usually have symptoms of severe heart disease (or hypertension, extensive MI, heart defects, ventricular tachyarrhythmia) with relatively normal pancreatic function. All this leads to a severe, acute increase in pressure in the pulmonary circulation (passive, retrograde pulmonary hypertension). Cardiac asthma and bronchial asthma are the two most common forms of paroxysmal shortness of breath, which should be distinguished, especially in emergency cases. Often with severe – BFB it is difficult to diagnose AD. But this is very important for a quick relief of an asthma attack. So, with it, AG (or atrovent) is usually inhaled, which are contraindicated in CA (increase the load on the myocardium and worsen the patient’s condition). The criteria for distinguishing AD from another pathology are given in the table. As can be seen from the table, bronchial obstructive syndrome is more common in young, healthy individuals with normal heart rate in AD. Whereas with cardiac asthma, it usually develops in elderly patients with severe heart damage and against the background of plasma extravasation into the interstitial tissue and alveoli (interstitial pulmonary edema). In patients with severe CHF, increased dyspnea (as an option for worsening CHF) may not be associated with a deterioration in myocardial function, but with the administration of large doses of a number of drugs (AAP, AB, NSAIDs, BMCC) or impaired renal and hepatic function) or due to the appearance of arrhythmias ( AF, PZhT), increased regurgitation on the valves or myocardial ischemia. An experienced doctor usually diagnoses typical bronchial asthma visually, already at the first stage of diagnosis of bronchial obstructive syndrome. So, in the history of AD patients there are indications of frequent attacks for many years (often against the background of existing COPD), and the attack has a characteristic clinical picture. The cause of an attack in AD can be exposure to allergens (odors, pollen, drugs, food) or provoking factors (viral and bacterial infection, cold). Patients with AD often have a characteristic allergic history – indications of past reactions to drugs (local or systemic) or aggravated heredity (for AD or other allergies). All this is not typical for patients with cardiac asthma. Unlike patients with bronchial asthma, patients with cardiac asthma do not occupy a certain position, they often sit in bed with their legs down (orthopnea position). An attack of cardiac asthma is accompanied by more severe symptoms (up tocardiogenic OL) than an asthma attack. In AD, during a seizure, the patient painfully coughs, but very little viscous, thick sputum is separated (or it does not go away at all). Only at the end of the attack, sputum begins to better be sprinkled. Whereas with a SC with a beginning transition to OL, on the contrary, sputum clears its throat easily and often in a larger amount (it may be foamy and pink). With the appearance of OL, sputum begins to liberate abundantly through the nose against the background of growing bilateral wet rales in the lungs.

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