Cardiac (cardiac) asthma is a severe clinical syndrome, which is the appearance of sudden attacks of suffocation. The main reason for an attack of cardiac asthma is a violation of the left heart (acute left ventricular insufficiency), which occurs most often against the background of the course of diseases of the circulatory system.
Cardiac asthma is characterized by a decrease in the performance of the myocardium and, as a consequence, stagnant conditions in the small circle of the circulation. The latter cause acute disorders in the respiratory and circulatory systems. The risk group includes people over 60, but the appearance of seizures at a young age is possible, as recently there has been a trend towards an increase in the incidence of cardiovascular diseases among young people.
Cardiac causes of asthma
The determining causes for this syndrome are acute left ventricular failure, mitral stenosis (narrowing of the mitral valve), aortic insufficiency. Deterioration of the left ventricle leads to interstitial edema of the lungs, which causes disturbances in the process of gas exchange in the lungs. There is shortness of breath, there are cases of development of reflex bronchospasm, which also aggravate the process of breathing. Disturbances in the work of the left heart can be caused by the presence of an intra-atrial thrombus or myxoma (intracavitary heart tumor).
These pathological processes usually appear with any disease of the circulatory system: myocarditis, acute coronary syndrome, aortic heart disease, postpartum cardiomyopathy, hypertension, arrhythmia , cardiosclerosis, heart aneurysm, etc. Dangerous paroxysmal upsurge of blood pressure (BP) with a significant load on myocardium of the left ventricle (hence its overstrain, for example, in the case of pheochromocytoma).
The risk of detecting an attack of cardiac asthma is present with an increase in the volume of blood circulation (fever, physical activity), the volume of circulating blood (the ingestion of a large quantity of fluid into the human body, during pregnancy ), with the patient in a lying position, and with a violent emotional disorder. In all cases, the flow of blood to the lungs increases. Before the attack, patients often feel discomfort in the chest area in the form of constriction, palpitation is felt, a cough is possible.
Some non-cardiac causes are also responsible for the development of cardiac asthma: infectious diseases (pneumonia, septicemia), acute circulatory disorders in the brain, acute glomerulonephritis (kidney disease), severe dependence on psychoactive substances, bronchial asthma , etc. The attack can develop as a postoperative complication.
Cardiac asthma symptoms
The main signs of cardiac asthma during wakefulness are shortness of breath, coughing, a feeling of tightness in the chest during minor physical work, with nervous tension or overeating, acceptance of a horizontal position.
However, in most cases, an attack of cardiac asthma catches a person by surprise at night, since during admission the adrenergic regulation is weakened and the flow of blood to the lungs increases. The patient wakes up from lack of air, dyspnea increases, which becomes choking. There is a dry cough with the separation of a later clear sputum or sputum of a pinkish stain with blood veins. The respiratory rate increases - the number of respiratory movements is 40-60 / min. at a rate of about 20 / min.
With an attack of cardiac asthma, a person is forced to take a vertical position, sitting down on the bed, as a result of this action dyspnea decreases (orthopnea), which brings some relief to the person. Breathing a patient through the mouth, speech is difficult. In the lungs dry rales are heard with whistles (in the case of bronchospasm), finely bubbly moist wheezing (when listening to the subscapular region, wheezing on both sides or only on the right side).
Auscultation of the heart becomes a time-consuming process, as when listening there are noises and rales. Nevertheless, when listening you can find out the deafness in the heart tones, single rattles or rales of scattered species. It is possible to identify the signs of a leading disease (failure of valvular valves, aortic valves, heart rhythm disturbance). X-ray examination of the chest will detect signs of stagnant blood in the veins and excessive blood in the small circle of the circulation. Transparent pulmonary fields, the roots of the lungs can be enlarged and blurred on the radiograph.
A sudden awakening due to an attack causes the patient to get excited, anxious, panic, growing into fear of death. Therefore, often patients with cardiac asthma are characterized by inadequate behavior, which complicates the process of providing them with first aid. Inspection of the patient allows you to detect cyanosis in the nasolabial triangle, cyanosis of the finger phalanges, an increase in diastolic blood pressure, tachycardia.
The attack of cardiac asthma, as a rule, lasts for several minutes or it can take up to 2-3 hours. The frequency of seizures and their peculiarity depend on the course of the underlying disease:
- in the case of mitral stenosis, seizures are rare due to the presence of Kitaev's reflex (reflex narrowing of the lumen of the pulmonary alveoli, which makes it difficult to stagnate in the capillaries, venous bed)
- attacks with acute right ventricular failure may completely pass.
Long attacks of cardiac asthma cause the appearance of "gray" cyanosis, cold sweating, cervical veins swell. There is a threadlike pulse and a drop in blood pressure, the patient feels a breakdown.
Cardiac asthma treatment
With cardiac asthma, due to the increase in the permeability of capillaries, the plasma enters the pulmonary tissues, especially in perivascular, peribronchial spaces. In connection with this, interstitial pulmonary edema develops. The result of this process is a violation of ventilation of the lungs and normal gas exchange between the lung alveoli and blood.
A separate role in the occurrence of an attack in neuroreflex links in the regulation of the breathing process, blood circulation in the brain. Excitation of the respiratory center due to irregularities in its blood supply or reflex reflexes (response to impulses from stimuli) leads to the development of autonomic symptoms during cardiac asthma.
In the process of treating cardiac asthma, it is necessary to conduct differential diagnosis of this disease with bronchial asthma (as well as with acute stenosis of the larynx, mediastinal syndrome, dyspnea with uremia, hysterical seizure). It compares with cardiac asthma with other manifestations of allergy .
Attacks of cardiac asthma occur with small changes in the respiratory rate, which is significantly hampered, and with an extended expiration time. Sputum when coughing in consistency resembles a viscous mucus. At exhalation swelling of veins of a neck which during an inspiration decreases is marked. There are signs of emphysema of the lungs (percussion), dry wheezes (during auscultation).
It is effective in differential diagnosis of an ECG at the time of an attack, the study of a cardiac asthma clinic, the collection of an anamnesis of the patient, an objective examination and chest X-ray.
If it is impossible to provide emergency medical care in case of an attack, a paramedic, a nurse, is engaged in urgent therapy of cardiac asthma. Preliminary preparation of the patient is reduced to its convenient location (half-sitting) and release of the neck and abdomen to facilitate breathing.
After that, the following tools can be used:
- administration of Furosemide intravenously;
- use of narcotic analgesics (Pantopone, Morphine). Analgesics are administered in combination with Atropine, in the case of tachycardia - along with Pipolphen, Suprastin instead of Atropine;
- if bronchospasm, edema of the brain and other complications developed, a neuroleptanalgic (Droperidol) is used;
- if it is necessary to reduce the load on a small circle of blood circulation, bleeding to 0.5 liters of blood is allowed;
- application of harnesses (if there are no contraindications);
- inhalation of oxygen for a long time, which must be repeated (carrying out the procedure through ethyl alcohol with a mask, nasal catheters);
- correction of blood pressure (use of antihypertensive drugs, use of diuretics;
- use of cardiac glycosides (Digoxin, Strophantine).
The result of an attack of cardiac asthma is determined, basically, by the course of the underlying pathology, which leads to the onset of seizures.
Most often the prognosis of cardiac asthma is unfavorable. However, the prevention of recurrence of seizures is possible during complex treatment and strict adherence to the patient's medical prescriptions. In this case, the patient's normal condition is maintained, working capacity is maintained for several years.
Carrying out the treatment of chronic ischemic heart disease, arterial hypertension, inadmissibility of the development of infectious diseases, as well as following the water-salt regime are the basis for the prevention of cardiac asthma and its attacks.
Cardiac asthma emergency care
At the first sign of cardiac asthma, you should call an ambulance, and in anticipation of her arrival - to give the patient first aid.
To reduce the load on the heart, to facilitate breathing, the patient is given a semi-sitting position, also it is necessary to release the throat and the whole body from the clutching garments (unfasten the collar, loosen the belly belt, if any, etc.). The patient is best placed at the open window for fresh air. It is recommended to make a bath for the feet, which will have a calming effect on the patient.
Before the ambulance arrives, the blood pressure should be monitored all the time (if a person has had problems with the cardiovascular system before the event with an attack of cardiac asthma, then a tonometer with a high probability will be present in his house). It is recommended to give the patient Nitroglycerin. The tablet is kept sublingually (that is, under the tongue) until it completely dissolves. After 5 minutes, the manipulation can be repeated, no more than 2 times. If you have a spray with nitroglycerin, you should give it preference. If the preparations containing Nitroglycerin are absent nearby, give the patient a tablet of Validol.
Efficacy with first aid is the application of venous tourniquets, after 5-10 minutes as a patient led to the state of semiside. If there is no special tourniquet, its role can be made by elastic bandage, kapron stocking. Harnesses are superimposed simultaneously in the number of 3 pieces: on both feet and arm. When applying a tourniquet on the legs, it is placed 15 cm from the inguinal fold, on the arm the location of the harness is 10 cm from the shoulder joint. After 15 minutes, the location of one bundle is changed by superimposing it on a free limb. The application of harnesses is used to create stagnation of blood in the limbs, thereby reducing the burden on the heart, reducing the likelihood of pulmonary edema. The correctness of the application of the harnesses is controlled by checking the pulsation of the arteries, on which the pulse should be palpable when probing below the harness location. Finiteness after squeezing with a tourniquet after a few minutes takes on a purple-cyanotic color.
A patient with an attack of cardiac asthma should be hospitalized in a hospital, despite the fact whether the attack was able to stop before the arrival of medical emergency workers. The main cause of the development of an attack of cardiac asthma will be found in the hospital, after which the doctor will prescribe the appropriate treatment.
Self-medication in the home and treatment of folk medicine are strictly prohibited. This can lead to complications of the disease or lead to a completely fatal outcome.