Cardiac asthma: what it is and what it is a symptom of

By Cristiano Antonino On Feb 10, 2023

Cardiac asthma is a symptom of a dysfunction of the heart, i.e. cardiac insufficiency, a condition in which the heart muscle can no longer provide the blood flow needed by the body

In heart failure, because the left ventricle cannot pump enough blood through the aorta, there is a build-up of incoming blood which in turn causes an increase in pulmonary blood circulation pressures, resulting in local congestion.

This is a condition suffered mainly by elderly individuals and involves symptoms very similar to those of bronchial asthma, i.e. wheezing, coughing and dyspnoea.

However, there are differences that have to do with the triggering causes: at the root of bronchial asthma is a disproportionate response of the muscular walls of the bronchial tree, whereas cardiac asthma is caused by impaired function of the heart pump.

Heart failure is one of the most significant health problems in industrialised countries, affecting 1-2% of the adult population and more than 10% of the population over 70 years of age.

Cardiac asthma, symptoms

Underlying the manifestation of respiratory symptoms of cardiac asthma is pulmonary oedema due to pulmonary venous hypertension, i.e. fluid accumulating in the alveoli and oedema of the mucous membrane of the bronchi.

These events in turn provoke a nervous bronchoconstriction reflex.

Typical symptoms of cardiac asthma are:

enlargement of the heart muscle in the left ventricle region (evident in the chest X-ray);
increased blood circulation time (measured by injecting sodium dehydrocholate into a vein in the arm and then measuring the time until a bitter taste is perceived on the tongue)

Cardiac asthma manifests itself suddenly, usually during the night when the subject is in clinostatism, i.e. when there is an increased return of venous blood to the heart.

Specifically, the symptoms are a feeling of suffocation and air hunger (dyspnoea).

Normally, sitting allows a rapid and spontaneous recovery within about 30 minutes.

If the symptoms occur during the day, there is an underlying cause such as a strong emotion, excessive physical exertion, paroxysmal arrhythmia (sudden and consistent alteration of the heartbeat frequency) and so on.

Differences between cardiac asthma and bronchial asthma

Bronchial asthma and cardiac asthma share a number of symptoms that may make differential diagnosis difficult.

These symptoms are:

dyspnoea (difficult and disordered breathing);
hissing, wheezing and whistling during breathing;
coughing with foamy sputum;
cold sweating and cyanosis (bluish discolouration of the skin).

However, cardiac asthma has specific symptoms, namely:

an enlargement of the heart muscle (especially in the left ventricle) detectable on an X-ray;
an increase in blood circulation time.

One must, in fact, consider that bronchial asthma is the consequence of a chronic inflammatory process of the respiratory tree, which is absolutely absent in cardiac asthma where the symptomatology is the consequence of cardiac problems.

The exact diagnosis of the disease is crucial because bronchial asthma and cardiac asthma require two different therapies, and incorrect treatment of cardiac asthma can lead to worsening, even serious worsening.

Causes

There are certain mechanical problems that impair the proper functioning of the left ventricle and cause cardiac asthma.

These include:

stenosis (i.e. narrowing) of the mitral valve, which controls the passage of blood from the left atrium to the left ventricle, leading to an increase in pressure that is transmitted to the pulmonary circulation;
obstacles in the outflow tract of the left ventricle that compromise its physiological emptying during the contraction phase, such as thickening of the pericardium, emboli, tumours, etc;
obstacles obstructing or compressing the pulmonary vein.

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Elements that can impair the contraction force of the left ventricle are:

impairment of myocardial muscle fibres as a result of an infarction or inflammatory processes;
pathologies that impair its function such as tachycardias.

Lastly, there may be an increased workload on the left ventricle due to:

aortic stenosis (a narrowing of the aortic valve requires the left ventricle to work harder to ensure sufficient blood flow to the body)
mitral regurgitation (consequence of an imperfect closure of the mitral valve during the systolic phase, resulting in an increased workload for the left ventricle)
aortic regurgitation (imperfect closure of the aortic valve during the relaxation phase of the heart muscle which decreases the arterial blood outflow and in order to compensate, the left ventricle must pump blood with greater effort).

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Diagnosis

The correct diagnosis of the disease is very important: it is diagnosed in a pre-hospital setting by the territorial assistance service.

Specifically, the doctor defines the patient’s clinical picture by identifying the parameters that may be useful in differentiating bronchial asthma and cardiac asthma, which, although minimal, do exist.

The parameters that the doctor attempts to identify are:

the enlargement of the heart detectable by an X-ray;
increased blood circulation time.

These are in fact the characteristic symptoms of cardiac asthma that differentiate it from bronchial asthma.

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The treatment of cardiac asthma involves taking medication

The underlying condition that must be treated to prevent the symptom from recurring is heart failure.

In fact, cardiac asthma involves acute treatment involving sedation and the administration of drugs to reduce lung congestion (with oxygen supplementation if necessary) and to increase the contraction force of the heart muscle.

Appropriate drugs and diuretics are often administered, namely:

Furosemide, a diuretic used to treat hypertension and fluid accumulation in the respiratory tract;
Nitroglycerin, which lowers blood pressure;
Morphine, which produces peripheral vasodilatation and hypotension by calming dyspnoea.

Once the asthma crisis has passed, it must be considered that it is not a pathology but the sign of a heart failure, so the actual therapy is the one that goes to cure this problem: its remission solves the problem of cardiac asthma.

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