Realistic plastic model of the heart

Cardiac Asthma: Causes, Symptoms, Treatment

Cardiac asthma is not asthma at all. This condition is characterized by wheezing or coughing, which are both symptoms of heart failure. In the case of cardiac asthma, extremely severe coughing/wheezing may mean this is a serious medical emergency.

When it comes to cardiac asthma, the heart is usually the root of the problem, as the organ has to significantly malfunction in order for the condition to occur. The collection of fluid is caused by the heart’s inability to pump blood powerfully and effectively, and the fluid buildup, in turn, leads to the narrowing of air passages. This fluid buildup is referred to as pulmonary edema. The pressure exerted by the left side of the heart, due to the unnatural disparity between its work load and capacity, is also responsible for cardiac asthma.

About Cardiac Asthma

Cardiac asthma is historically most prevalent in elderly people, but the condition is not exclusive to this demographic by any means. Cardiac asthma can and does appear in people of all ages, especially those with other ailments of the heart and a natural tendency for unhealthy fluid accumulation. For example, those with leaky heart valves and/or gaps between the heart’s chambers are known to be especially prone to cardiac asthma, even at a young age.

When someone suffers from heart failure, fluid builds up in the lungs inside of, and surrounding, the patient’s airways – this is called pulmonary edema. The direct result of pulmonary edema are the symptoms of cardiac asthma: inability to catch one’s breath, wheezing, and coughing, which may seem similar to asthma.

However, cardiac asthma is not asthma at all. Whereas asthma is a condition where one’s airways become inflamed and narrowed, leading to breathing difficulties, cardiac asthma is caused by heart disease and fluid in the lungs.

While cardiac asthma is mostly caused by internal factors, external influence plays a larger role in true asthma, which is brought on by tightness in the chest, in addition to shortness of breath, wheezing and coughing. True asthma can be triggered by things such as weather, smoke and pollution.

Since cardiac asthma and true asthma are two distinct medical problems, the common treatments for true asthma can have the reverse effect when cardiac asthma is concerned. Inhalers and therapies medications meant for asthmatics can make the symptoms of cardiac asthma worse and even cause irregular heartbeats. Thus, it is important to approach cardiac asthma from the correct angle in order to alleviate the symptoms and properly manage the sickness.

Signs and Symptoms of Cardiac Asthma

The signs and symptoms of cardiac asthma vary in their intensity from person to person but the surface especially after exercise or while sleeping. The main symptoms of cardiac asthma are shortness of breath, rapid shallow breathing or chest pain, accelerated heart rate, high blood pressure or swelling of the ankles. Symptoms can worsen over time and can wake you in the middle of the night because of shortness of breath. Swollen ankles are characteristic of cardiac asthma that you might see in a normal condition of asthma.

Both cardiac asthma and pulmonary edema are symptoms of coming heart failure. It is a life-threatening condition and one must seek medical advice immediately on experiencing any symptoms.

Some of the main symptoms are:

  • Shortness of breath, not necessarily accompanied by wheezing.
  • Increased rapid and superficial breathing.
  • Increased blood pressure and heart beat rate.
  • A feeling of uneasiness.

Cardiac asthmatic people wake up breathless a few hours after sleeping, and have to sit upright to again properly breathe. This is due to lying down too long.

Swollen ankles which worsen rapidly during the stretch of the day.

Causes of Cardiac Asthma

Usually, cardiac asthma is due to major mechanical heart failure. This may be a life-threatening situation, if not checked properly and at right time. In this, heart pumping efficacy is reduced and builds up fluid in lungs. This leads to narrowing of air passages and hence, causes wheezing and other problems.

1. Problems with Heart Valves

Pulmonary edema can result from problems with the valves in the heart. If the mitral opening narrows–a condition called mitral stenosis–the amount of blood reaching the left ventricle diminishes, resulting in a back-up in the pulmonary veins. The mitral opening separates the left atrium and ventricle. This occurs, most often, as a result of rheumatic heart disease, in which the mitral valves and chordae tendineae thicken and stiffen. Chordae tendineae keep the mitral valve from backing up into the atrium, a condition called mitral valve prolapse. After blood reaches the left ventricle, the aorta carries it on to the rest of the body. If the aortic valve narrows (aortic stenosis), a diminished amount of blood can leave the ventricle. Also, in a condition called aortic regurgitation, blood that reaches the aorta flows back into the ventricle due to dysfunction of the aortic valves. These aortic valve problems can cause the back-up that results in pulmonary edema.

2. Cardiac Muscle Dysfunction

Pulmonary edema can occur as a result of several heart muscle problems. The most common cause is abnormal systolic function–problems with the heart during the contraction phase of a patient’s heartbeat. Diseases that cause systolic dysfunction include coronary artery disease (CAD), a toxin present in the blood stream, and myocarditis, which is inflammation of the heart muscle. Systolic dysfunction causes increases in pulmonary venous pressure because the volume of blood being pushed from the heart is less than the amount being sent to the heart, causing a back-up in the pulmonary vessels. Diastolic dysfunction can also cause pulmonary edema. Causes of dysfunction during diastole, the relaxation and filling phase of hearbeat, include heart muscle diseases, lack of blood flow and high blood pressure.

3. Pulmonary Venous Pressure

The immediate cause of pulmonary edema is simply an increase in pulmonary venous pressure, meaning that more blood than usual is in the veins that run between the lungs and the heart. This is known as backward failure. With the rise in pressure, there is little time to compensate for the increased vascular volume; the layer of cells that allows only gases to permeate begins allowing fluid to pass. This fluid builds up in the lungs’ spaces, and breathing becomes restricted and difficult.

4. Other Causes of Cardiac Asthma

The other causes of cardiac asthma are less common, but worth noting. Narrowing of the renal artery, or renal artery stenosis (RAS), can cause pulmonary edema. In some cases, edema has been the only symptom by which RAS was diagnosed. A benign tumor of the atrial wall, called atrial myxoma, and a blood clot inside the heart, known as an intracardiac thrombus, may also present pulmonary edema as a symptom.

Doctor holding stethoscope

Diagnosis of Cardiac Asthma

Cardiac asthma attacks caused by the escalation of pulmonary edema is an extraordinarily serious form of medical emergency. Indeed, this condition is one where the patient outcome depends heavily on swift treatment. Fast-executed treatment can result in rapid and satisfactory resolution of the emergency.

A chest x-ray usually reveals the presence of fluid in your lungs that indicates your symptoms are caused by cardiac asthma rather than lung or bronchial asthma. To diagnose heart failure, doctors rely on EKG, cardiac stress tests and imaging techniques like echocardiograms and CT scans, explains the National Library of Medicine.

Cardiac Asthma Treatment

The core to managing cardiac asthma is understanding the symptoms to identify what’s wrong. Medical professionals will approach cardiac asthma by making sure to differentiate between those people who cough due to their heart failing, versus people who cough due to other conditions like asthma, pulmonary disease, acute respiratory distress, or pneumonia.

To treat cardiac asthma, your doctor may focus on helping the heart to pump blood more effectively. This may include the use of medications, or in the case of a heart valve issue or hole in the heart chambers, potentially surgery.

Treating cardiac asthma is very much about treating heart failure. This may mean taking diuretics to help remove excess fluid from the lungs, and taking medications to support the heart muscles so they can pump properly. As treatment progresses, the coughing and shortness of breath that are common in cardiac asthma should get better over time.

Corticosteroids are prescribed only when the patient with acute cardiac asthma has not responded well to initial therapy. Corticosteroids usually take long hours to give peak effect. If the asthma is caused by a heart valve that is not working properly or a hole between the heart chambers, surgery or other procedures may be suggested.

Who is Prone to Cardiac Asthma?

Although cardiac asthma can affect anyone, this condition usually occurs in people who are likely to have reduced heart function. As a result, this condition is most common in elderly people and chronic smokers.

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