Cardiac Asthma: Causes, Symptoms, and Treatment

Introduction

Cardiac asthma is not a form of traditional asthma. Instead, it is a condition caused by heart failure, leading to fluid buildup in the lungs and difficulty breathing. Understanding the connection between heart failure and respiratory symptoms is critical for managing this condition effectively.

Causes

The primary cause of cardiac asthma is left-sided heart failure. When the left ventricle cannot effectively pump blood, fluid backs up into the lungs, leading to pulmonary congestion. Common underlying conditions include:

• Coronary artery disease (CAD): Reduced blood supply weakens the heart muscle.
• Hypertension: Increased blood pressure strains the heart.
• Cardiomyopathy: Diseases of the heart muscle impair function.
• Heart valve disorders: Problems with the mitral or aortic valves can contribute to pulmonary congestion.

Symptoms

Cardiac asthma mimics bronchial asthma but has distinct features:

• Shortness of breath (dyspnea), often worse at night.
• Wheezing and coughing, especially when lying flat.
• Sudden episodes of breathlessness (paroxysmal nocturnal dyspnea).
• Pink, frothy sputum, which may indicate pulmonary edema.
• Rapid heart rate (tachycardia) and increased blood pressure during attacks.

Diagnosis

Diagnosis involves distinguishing cardiac asthma from bronchial asthma. Important evaluations include:

• Physical examination: Listening for crackles in the lungs and checking heart sounds.
• Echocardiography: Assessing heart function and structural abnormalities.
• Chest X-ray: Identifying signs of pulmonary congestion.
• BNP (B-type natriuretic peptide) test: Elevated levels suggest heart failure.
• Electrocardiogram (ECG): Detecting underlying heart disease.

Treatment

Immediate Relief

• Oxygen therapy: Helps improve oxygen levels.
• Diuretics (e.g., furosemide): Reduce fluid overload.
• Nitrates (such as nitroglycerin): Help reduce heart workload.
• Morphine (in severe cases): Reduces respiratory distress and anxiety.

Long-term Management

• Treatment of heart failure with ACE inhibitors, beta-blockers, and aldosterone antagonists.
• Lifestyle modifications, including sodium restriction, weight management, and fluid balance.
• Regular monitoring: Blood pressure, kidney function, and heart function.
• Avoidance of triggers: Excessive fluid intake, high sodium diet, and lying flat immediately after eating.

Conclusion

Cardiac asthma is a serious condition requiring prompt and effective treatment. By managing heart failure properly and taking preventive measures, patients can significantly reduce symptoms and improve their quality of life.

Source recommendations

1. American Heart Association Guidelines for Heart Failure Management

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
2. https://professional.heart.org/en/guidelines-and-statements
3. https://www.heart.org/en/health-topics/heart-failure
4. https://pubmed.ncbi.nlm.nih.gov/35363499/
5. https://www.heart.org/en/professional/quality-improvement/get-with-the-guidelines/get-with-the-guidelines-heart-failure

2. European Society of Cardiology Guidelines for Acute and Chronic Heart Failure

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
2. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Focused-Update-on-Heart-Failure-Guidelines
4. https://pubmed.ncbi.nlm.nih.gov/34447992/
5. https://academic.oup.com/eurheartj/article/44/37/3627/7246292