• Cardiac asthma - Causes, symptoms and treatment. MF.

    Causes of cardiac asthma
    Symptoms of
    Treatment and lifestyle
    Complications and prognosis

    In the human body, the blood supply of all organs and systems is provided by small and large circles of circulation. A small circle encompasses an influx of venous blood from the right ventricle of the heart into the lungs, oxygen saturation in the pulmonary alveoli, and transportation of oxygen-enriched blood through the pulmonary veins to the left atrium. Then the blood through the left ventricle enters the aorta, spreading along the arteries of all organs, ensuring the supply of oxygen in them, and after gas exchange in tissues, oxygen-depleted blood passes through the system of hollow veins into the right atrium - this is a large circle of blood circulation.

    If, for some reason, the heart can not cope with the pumping of blood, then blood stasis arises in the organs of the large and small circles of the circulation. Violation of the contractility of the left heart, as well as mechanical obstacles to the blood flow in them lead to the fact that the blood can not flow from the lungs to the heart and stagnates in the capillaries and veins of the lung tissue.

    Increased vascular blood vessels are captured by baroreceptors located in the vascular wall, and signals about it are transmitted to the respiratory center of the nervous system. There is a reflex stimulation of the center, the frequency of respiratory movements increases, which is clinically manifested by shortness of breath and attacks of suffocation. The described processes are characteristic for such clinical syndrome as cardiac asthma.

    Cardiac asthma is a manifestation of acute left ventricular failure, which is characterized by congestion of venous blood in the vessels of the lung tissue and is clinically expressed in attacks of severe dyspnoea and / or suffocation. Sometimes, in the absence of therapeutic measures, cardiac asthma can go to cardiogenic( cardiac) pulmonary edema, due to exceeding the critical level of pressure in the pulmonary capillaries, sweating the liquid part of the blood into the alveoli( pulmonary vesicles) and then foaming this fluid with a stream of air passing during breathing.

    By itself, cardiac asthma is not a life-threatening condition, and can even stop on its own, but sometimes it can lead to the development of pulmonary edema within a few minutes, which is a threat to the patient's life.

    The figure shows a violation of myocardial contractility, in which the proper volume of blood can not be discharged into the aorta( 2), in contrast to the normally functioning heart( 1), resulting in increased pressure in the left ventricle, then in the left atrium and pulmonary veins.

    Causes of cardiac asthma

    Causes of cardiac asthma can be any cardiac disease that has heart failure in its outcome. Such diseases are the following:
    - heart diseases, most often stenosis of the mitral valve
    - ischemic heart disease
    - acute myocardial infarction
    - postinfarction cardiosclerosis
    - left ventricular aneurysm
    - arterial hypertension, hypertensive crisis
    - paroxysm of atrial fibrillation
    - myocarditis,postmiocardic cardiosclerosis
    - cardiomyopathy( hypertrophic, dilated, restrictive)
    - intracardiac thrombus
    - heart tumor( myxoma)
    - acute and xonichesky glomerulonephritis( with the development of hypertension)

    The figure shows that with ventricular myocardial hypertrophy volume decreases, resulting in blood "stagnated" in the atria and vessels flowing into the atrium, in particular in the pulmonary veins.

    The triggering factors that can cause an increase in pressure in the pulmonary capillaries are excessive psychoemotional or physical exertion in patients with these diseases. Also, episodes of cardiac asthma can appear during pregnancy against the background of existing cardiac diseases, with fever in patients with chronic heart failure.

    Symptoms of cardiac asthma

    Precursors of cardiac asthma may appear even two to three days before the development of the episode itself. The patient on a background of increased stress is concerned about weakness, fatigue, a feeling of tightness in the chest, the impossibility of deep inhalation full of chest. Most often, an asthma attack occurs at night, due to the fact that in the horizontal position the blood flow in the lungs slows down, and the venous inflow to the heart increases. The patient can not fall asleep or drastically wakes up from what feels like choking, can not breathe deeply. Increases the frequency of respiratory movements, there is a dry obsessive cough, sometimes with scant sputum or blood veins. There is a sticky cold sweat, the patient can feel the fear of death. The blueing of the nasolabial triangle and the skin of the fingers develops( acrocyanosis).The patient tends to assume the position of orthopnea - sitting with the support of the hands, as in the vertical position the venous return of blood to the heart decreases slightly, which can cause temporary relief.

    The patient should remember that the best solution in such a situation will be to call an ambulance team, since only a doctor can compare the symptoms and the need for admission to a hospital with a therapeutic and diagnostic purpose.

    Diagnosis of cardiac asthma

    The diagnosis of cardiac asthma can be assumed even during the clinical examination of the patient. In favor of his testify to the characteristic complaints of rapid breathing and suffocation in a patient with an existing cardiac disease. In rare cases, an attack of cardiac asthma can occur suddenly, against a background of complete physical well-being as a result of the development of a painless form of myocardial infarction, rupture of the left ventricle aneurysm, hypertensive crisis without previous subjective sensations.

    When listening to the chest, deaf cardiac tones are identified, the tone of the second tone is at the aortic listening point, irregular heartbeats, pathological tones and noises characteristic of heart defects, small bubbles or dry wheezing in the lower lungs or across all pulmonary fields. When probing the abdominal cavity organs, there may be an enlarged liver, which indicates the stagnation of blood in the organs of the great circle of blood circulation. Arterial pressure may be elevated, low, or remain within normal limits. The appearance of a wet cough with foamy sputum, wet wheezing in the lungs indicates the development of pulmonary edema, and a sharp decrease in blood pressure - about the development of collapse, which requires urgent medical measures in the conditions of the cardiac recovery department.

    Of the additional survey methods, the following are assigned:

    - ECG allows to identify signs of left ventricular overload( displacement of the electric axis of the heart to the left, high R tooth in the left thoracic leads - V1-2, conduction disorders( complete or partial blockages) on the left leg of the bundle), signs of myocardial ischemia or acutemyocardial infarction, signs of heart defects( changes in the P wave, characteristic of the right or left atrial overload, hypertrophy of the ventricular myocardium, etc.).
    - chest X-ray of the shows signs of an intensified pulmonary pattern caused by the vascular component, as well as an expansion of the heart shadow across.
    The given events at the level of the admission department of the cardiological hospital are enough to hospitalize the patient with cardiac asthma as soon as possible to the department for carrying out medical and diagnostic measures. In the department, a further examination is carried out, including the following diagnostic methods:
    - echocardiography( ultrasound of the heart) allows to establish a more accurate diagnosis - heart disease, acute or transferred myocardial infarction, left ventricular aneurysm, cardiomyopathy and other diseases that cause contractilemyocardial dysfunction of the left ventricle. There are also signs of hypo- or akinesia( reduction or absence of myocardial contraction in certain areas of the heart), a decrease in stroke volume and a fraction of the left ventricular ejection, increased pressure in the left atrium and pulmonary veins( pulmonary hypertension).
    - MRI of the heart can be prescribed for clarification of the localization and degree of involvement of the heart muscle
    - when the life threatening symptoms are relieved, CAG( coronaroangiography) is urgently administered to patients with acute myocardial infarction( no later than six hours from the onset of development) forthe restoration of blood flow through the clogged coronary artery, and in a planned manner to persons with ischemic heart disease to decide the feasibility of stenting the coronary arteries.

    The doctor needs to remember how to distinguish between cardiac and bronchial asthma. With bronchial asthma, it is difficult to exhale( respiratory expiration), breathing is wheezing, the patient can not clear hard-to-remove vitreous, viscous sputum, dry wheezing sounds are heard in the lungs. With cardiac asthma, it is difficult to inhale( shortness of inspiration), the patient can not breathe in full, breathing noisy, bothersome dry cough, no sputum or scant amount with veins of blood, small, bubbly or dry rales are heard in the lungs.

    Differential diagnosis is important, because the tactics of treatment for these diseases are significantly different. The appointment of diuretics for cardiac asthma is justified, while in bronchial asthma, their use can significantly increase the patient's condition. This is due to the fact that diuretics remove fluid from the body, so sputum in the bronchi becomes even more viscous and dense, finally blocking their lumen.

    Treatment of cardiac asthma

    Treatment of cardiac asthma is carried out in a cardiac or therapeutic hospital, if necessary - in the intensive care unit.

    At the pre-hospital stage, waiting for the arrival of an ambulance brigade, the patient or his relatives can ease the condition as follows. The patient should take a comfortable position in bed while sitting down with his legs down, measure blood pressure with a home tonometer, open the window for fresh air, put 1 and 2 tablets of nitroglycerin under the tongue every 5 minutes for 15 minutes under pressure control( ifpressure below 90/60 mm Hg, you can not take nitroglycerin) for the expansion of pulmonary and coronary vessels, you need to organize a hot foot bath, putting the foot and shins into the hose with hot water. This is necessary for the veins of the legs to expand and contain more blood, thereby reducing the flow of blood to the heart.

    Upon the arrival of the doctor, after the patient is transported to the hospital and hospitalized, the following groups of drugs are administered:

    - nitroglycerin intravenously reduces venous blood flow to the heart,
    - lasix or furosemide intravenously removes fluid from the body, contributing to a decrease in the volume of circulating blood, and in the pulmonary vessels as well. These drugs, as well as nitroglycerin, contribute to lowering blood pressure, therefore, with a low level of blood pressure in a patient, therapy should be carried out together with drugs that increase the tone of blood vessels and blood pressure, for example, with mezaton, dopamine and other cardiotonic drugs,
    - strophantine is administered intravenouslyto improve the contractility of the heart muscle, and to restore heart rhythm disturbances, for example, in paroxysm of atrial fibrillation,
    - euphyllin is an antispasmodic, relaxes smoothlyincluding those in the vascular wall, which is necessary to improve pulmonary blood flow,
    - narcotic analgesics( morphine derivatives) can be prescribed to stop the pain syndrome in case of an infarction and to reduce the activity of the respiratory center, as well as antipsychotics( droperidol) to eliminatepanic, fear of death and prevention of respiratory depression,
    - therapy of the underlying disease( correction of hypertension, rhythm disturbances, treatment of myocardial infarction, heart defects, etc.)

    Lifestyle with cardiac asthmamy

    For the patient who has suffered attacks of cardiac asthma, the measures aimed at the prevention of repeated attacks are relevant. These include:

    - elimination of stresses, restriction of significant physical exertion
    - organization of the right daily routine with a sufficient night sleep( not less than 8 hours) and rest during the day
    - organization of proper nutrition with the exception of alcohol, coffee,cigarettes, fatty, spicy, fried foods;with restriction of the use of table salt, a drunk liquid, fats of an animal origin, fat kinds of meat, a fish and a bird;with a high content of sour-milk products in the diet, as well as fresh fruits, vegetables, cereals, vegetable oils as sources of vegetable proteins, carbohydrates and fats.
    - regular intake of medications prescribed by a doctor, timely visit to the treating doctor
    - the patient's working capacity in the absence of a disability for the underlying disease maybe restored after discharge from the hospital according to the usual periods of temporary incapacity for work on the sick leave sheet.

    Complications of cardiac asthma

    Without treatment, the complication of an attack of cardiac asthma is its transition to the stage of alveolar pulmonary edema, which refers to life-threatening conditions.

    Prevention of edema is the timely provision of emergency care and hospitalization in a hospital with a thorough examination and treatment of the underlying disease.

    prognosis Without prophylaxis, the prognosis may be unfavorable, since the risk of cardiac asthma transition to pulmonary edema is high, which can lead to death.

    With a successful arrest of an attack and regular intake of drugs prescribed for the underlying disease in order to reduce the progression of venous stasis in the lungs, the prognosis is favorable.

    Doctor therapist Sazykina O.Yu.