Update: November 2018 Asthma (Greek Asthma – suffocation) in medicine
called an attack of shortness of breath that occurs suddenly and
periodically repeating. Causes of paroxysmal dyspnea may
be different, but most often this term is used in reference to
bronchial asthma (as an independent disease) and cardiac
asthma (as a syndrome in various diseases of the cardiovascular
Механизм развития cardiac asthma
Our heart is a pump. It is divided into two halves – the left and
right. Each half has an atrium and ventricle communicating
between themselves and separated by valves.
Blood from the lungs (from the pulmonary circulation),
falls into the left atrium, from there – into the left ventricle, which
is the most powerful camera of our heart. He pushes blood into
the aorta and then it goes through the great circle of blood circulation to all
organs and tissues of our body.
The contraction of the left ventricle to release a portion of blood is called
systole. After contraction, the heart muscle relaxes.
(diastole), the camera is again ready to accept the next portion of blood from
In situations where the left ventricle cannot push the entire
blood, it accumulates in him and, accordingly, in diastole he already
can take blood from the atrium less than necessary. In him
diastolic pressure increases, it grows in a chain reaction and
auricles and pulmonary veins and capillaries. But since blood volume
remains constant, she needs to go somewhere. Liquid part of blood
(plasma) due to increased pressure seeps through the wall
pulmonary capillaries and goes to the interstitial tissue, which
surrounds the small bronchi and alveoli.
At some point in time, the fluid accumulates so much that
she squeezes small bronchi, leads to their edema. Consequence of this
and becomes an attack of suffocation.
Таким образом, приступ cardiac asthma – это синдром
left ventricular or left atrial failure (less common). Also
its synonym is interstitial pulmonary edema. With
the progression of pathology, it can go into alveolar edema,
when fluid sweats into the cavity of the alveoli. Choking with this
intensified and without treatment such a condition can lead to
So, three major pathogenetic
- Heart muscle weakness.
- Increased resistance at the exit of the left ventricle.
- Overloading left chambers with excess blood volume.
Withчины cardiac asthma
Cardiac asthma is not an independent diagnosis, but a syndrome
which can be in various heart diseases. All these
diseases have their symptoms, their pathogenesis, their stages
flow. But in one not very beautiful moment they come
aggravation similar for all – acute failure of the left sections
heart, which leads to an attack of choking.
Consider the main diseases that can to this
- Acute myocardial infarction. As you know, a heart attack is death
parts of the heart muscle. Some part of the myocardium just turns off
from work and can not perform its pumping function. therefore
In addition to pain and pressure drop, a heart attack can also manifest itself.
cardiac asthma. There is also an atypical form of heart attack.
myocardium – asthmatic, which is manifested only by suffocation.
- Postinfarction scar. Not only fresh heart attack, but also earlier
postponed can cause a sharp decrease in heart
- Alcoholic cardiomyopathy. Cardiac dystrophy occurs
muscles, chambers of the heart are stretched and do not contract with due
- Myocarditis. Inflammation of the heart muscle of various origins
also leads to its weakening
- Stenosis of the aortic valve. Defect valve, often after
suffered rheumatism. The narrowing of the opening leading to the aorta
leads to the fact that the left ventricle is forced to overcome a large
resistance and work at the limit. Its walls at the same time
thicken, but at some point it still can not cope with
- Hypertonic disease. Механизм развития cardiac asthma при
this pathology is similar to the previous paragraph: the increase in pressure in
aorta, hypertrophy of the heart muscle, failure of the left
ventricle. Acute failure occurs with a sharp jump
pressure (hypertensive crisis).
- Mitral valve insufficiency. This vice is characterized by
in that the valve between the left atrium and the ventricle is not fully
closes during systole. The blood in the ventricle continues
do, disrupting his normal work. Blood volume
increases, pressure in the left atrium increases. Then – all
on the same circle (small).
- Mitral stenosis. Here the mechanism is somewhat different, and concerns
mainly auricles: due to narrowing of the mitral orifice
the atrium cannot siphon off all the blood that has accumulated in it
- Heart rhythm disorders. Various tachycardias, arrhythmias lead
to the fact that the harmonious work of the heart chambers is disturbed, the volume of blood,
pumped over the cardiac cycle, decreases. Diastolic
pressure in the left ventricle rises, further mechanism former.
- Tumors or blood clots in the chambers of the heart. Not so frequent reason
но впервые может проявиться именно cardiac asthma.
- Acute or chronic renal failure. Kidneys not
completely remove urine, blood volume increases. Heart (especially
if it is already unhealthy) can not cope with excess
Факторы, провоцирующие приступ cardiac asthma
Patients with chronic cardiovascular disease with
observance of the proper mode, proper nutrition and performance
all appointments can live a lifetime and never experience
yourself heart asthma.
The provocative moments for an attack are:
- physical exhaustion;
- nervous tension, stress;
- alcohol intake;
- receiving large amounts of salt and liquid;
- intravenous infusions of various solutions (in resuscitation, after
operations, with infectious diseases);
- lower respiratory diseases – bronchitis,
- long bed rest;
- abundant food and drink at night;
How is cardiac asthma manifested
Cardiac asthma rarely occurs among full health. how
typically, these patients already have signs of chronic heart
failure, that is, shortness of breath during exercise for them –
commonplace But at rest, she usually does not bother them. Here we are
dealing with adherence to chronic acute cardiac
failure, and the new symptoms and the suddenness of their appearance
Симптомы cardiac asthma появляются чаще всего ночью, когда
man lies. This is because in a horizontal position
blood flow to the heart increases.
A person wakes up from breathing heavily, begins
dry cough. He begins to breathe deeper and more often. Reflexively sits
– so it is easier for him.
From the side of such a patient looks pale, lips and nasolabial
the area is cyanotic. Increased breathing, and more difficult to give
inhale. His face and chest are covered with cold sweat, his hands are usually
rests on the headboard of the bed or chair.
Due to the fact that asphyxiation developed so suddenly in a patient
a panic begins, the heartbeat increases from this and
condition only aggravated.
Withступ может длиться несколько минут, а может и несколько
hours Sometimes it’s enough to sit down, lower your legs, open
форточку и состояние is improving. Sometimes without an ambulance
get along. In severe cases without treatment, cardiac asthma can
go into the pulmonary edema, and here already the bill goes on for minutes.
What is the difference between cardiac asthma and bronchial
At first glance, the signs of heart and bronchial asthma are similar.
Both are manifested by a sudden onset of choking,
more often at night. Sometimes even medics without a special examination.
difficult to distinguish.
But it is still possible to distinguish them, and it is very important not to be mistaken, because
that the treatment they have is fundamentally different.
|Bronchial asthma||Cardiac asthma|
Age often young, up to 40 years
Prior conditions – odor allergy, prolonged
Blood pressure is more normal.
Heart rhythm is not broken
During the attack – expiratory dyspnea (difficult to exhale),
It is more common in older people.
how правило, уже имеется известная больному сердечная патология
Pressure is often elevated
Heart rhythm disturbances are often noted – rapid heartbeat
With fit затруднен вдох («не надышаться»), хрипов мало
Help with cardiac asthma
Впервые возникший приступ cardiac asthma вызывает страх и
panic, so the patient, as a rule, causes an ambulance. With
recurring seizures he can learn to relieve himself
Withступу обычно предшествуют предвестники: сухое покашливание,
which appears in the prone position. This is evidence of edema.
Basic principles of care for cardiac asthma and edema
- Reduce venous flow to the heart (diuretic drugs,
- Decrease the resistance of the left ventricle (decrease
total blood pressure, nitroglycerin preparations for
reduce peripheral vascular resistance).
- Soothe the patient (sedative medication).
- Strengthen cardiac output (cardiac glycosides, others
- Reduce hypoxia (oxygen).
- Reduce the frequency of heart contractions (antiarrhythmic
facilities, сердечные гликозиды).
What you can do at home
- Sit down, lower the legs.
- Try to calm down.
- Open the window.
- Measure the pressure.
- With повышенном или нормальном давлении взять под язык таблетку
nitroglycerin, drink a tablet of furosemide. With низком давлении
immediately call an ambulance, the situation is better to take
- From the old methods allowed foot bath with warm water
or venous harnesses on limbs for a short time (as harnesses
Kapron stockings are quite suitable). Previously used bloodletting
doing this now is not worth it, but as a last resort in emergency
situations and lack of medical care is fully justified.
What the ambulance doctor will do
- Examine, assess the condition of the patient and decide
assistance at home, hospitalization or immediate
- Will remove an ECG.
- Intravenous diuretic drug (lasix).
- Re-nitroglycerin under the tongue, in severe cases –
- Sedative drug (Relanium, in the case of pulmonary edema –
- With tachycardias and atrial fibrillation – cardiac glycosides
(strophanthin or digoxin intravenously).
- Oxygen inhalation.
Usually these events are enough, the patient’s condition
is improving. He receives recommendations to call a doctor from the clinic
or make an appointment yourself for an examination or
The main drugs for the relief of cardiac asthma
|Group of drugs||Operating principle||Representatives||Mode of application|
|Nitrates||Expand small vessels, reduce peripheral resistance,
reduce blood flow to the heart
Under the tongue in the form of tablets, capsules, spray
|Sibazon, Relanium||Intramuscularly or intravenously|
Reduce the excitability of the respiratory center,
||Subcutaneously, intramuscularly or intravenously|
|Diuretic||Reduce the volume of circulating blood, reduce pressure||
||Intramuscularly or intravenously|
Reduce the pressure
Under the tongue
Intramuscularly or intravenously
B / vein drip
|Oxygen||Reduces hypoxia, reduces the formation of frothy sputum.||
Or a mixture of oxygen with vapors of alcohol
|Inhalation through nasal catheters|
|Cardiac glycosides||Strengthen myocardial contractility, increase stroke volume,
|Impact on polarization processes in the myocardium, relieve
When will hospitalization be necessary?
- With an unclear diagnosis.
- If you suspect an acute myocardial infarction.
- With the first arisen attack of arrhythmia.
- With the development of the clinic of alveolar pulmonary edema (even after
improve the state).
- With low blood pressure.
- In the absence of the effect of all events held.
Diagnostic algorithm for sudden suffocation
the same for both emergency cases and for planned
examination. In case of emergency hospitalization, a survey will be conducted.
quickly (in really difficult situations immediately).
If the attack was stopped and the patient was sent in the morning to
clinic, will have to tune in for not very soon examination and
consultations with different specialists.
What research is usually prescribed
- ECG. On a cardiogram, you can see signs of acute myocardial infarction.
myocardium, acute arrhythmia. With chronic
diseases in the descriptions of the ECG may be different formulations:
left ventricular hypertrophy, blockade of the bundle branch foot, abnormalities
electrical axis of the heart, disorders of repolarization.
- Analyzes Complete blood count can indicate the severity of the process.
So, during a heart attack, there is an increase in ESR, leukocytes, CPK,
- Radiography of the lungs. X-ray in interstitial
pulmonary edema shows a fuzzy, “smeared” pulmonary pattern, reducing
transparency in the root zones, the expansion of interlobar
partitions. The shadow of the heart is usually increased.
- Spirometry Such a study is conducted when there is still
suspected bronchial seizures. With bronchial
asthma will decrease PSV values (peak expiratory flow rate) and
FEV1 (forced expiratory volume in 1 s), although a single
measurement is not 100% criterion of diagnosis,
it is necessary to measure them several times during the day, as well
after the use of bronchodilators.
- Echocardiography (ultrasound of the heart). Perhaps the most important method
studies of the heart and assess its functional ability.
It allows you to determine the size of the chambers of the heart and the pressure in them,
wall thickness, valve condition, blood flow. With his help
Valve defects, damage to the heart muscle can be detected,
regurgitation (reverse stroke) of blood.
What signs on the CG ECHO can confirm that we are dealing
exactly with heart asthma?
- Expansion of the left ventricle and left atrium.
- Reduced stroke volume.
- Reducing the ejection fraction (normally at least 50%).
- Valve pathology (stenosis, insufficiency).
- Increased pressure in the pulmonary artery (normally should not
exceed 25 mm RS
- Hypo- or akinesis of the walls of the left ventricle.
- Regurgitation (reverse blood flow through the mitral
In addition to these basic studies, others are often prescribed:
- Daily monitoring ECG.
- Bicycle ergometry.
- Extraesophageal echocardiography.
- Coronary angiography (CAG).
Prevention of heart attacks
As already mentioned, cardiac asthma is not independent.
diagnosis, and the complication of many heart diseases. Overwhelmingly
In most cases, the patient is aware of his illness, but
not all receive adequate treatment, and it’s often the fault
patient (“a lot of pills, I will not drink them,” “I’m afraid
operations “, etc.)
However, having experienced at least one attack of cardiac asthma, people
begin to fear his repetition, afraid to suffocate and begin
listen to the advice of doctors.
What should be done to prevent an attack?
- Complete all scheduled examinations to determine exactly
diagnosis or clarification of the stage of the disease.
- When making a diagnosis, take all drugs prescribed
cardiologist. Doses must be adjusted under supervision.
doctor, do not cancel or reduce yourself.
- Regularly monitor your pressure and pulse.
- In case of flaws in valves, an operation is indicated; consultation is necessary.
Lifestyle recommendations for the prevention of seizures
- Do not overwork, comply with the regime of work and rest. Feasible
exercise is usually not contraindicated. Worth walking
Every day, especially good before bedtime walks. Sleep should not be
less than 8 hours a day.
- Give up alcohol and smoking.
- Sleep should be with an elevated head end.
- Avoid stress, nervous tension. Not at all to leave
succeeds, but some foreseen situations can be avoided. Especially
impressionable people can take sedatives
(only prescribed by a doctor).
- Avoid hypothermia and acute respiratory infections,
be vaccinated against the flu.
- Food should be easily digestible, with animal restriction.
- The main cooking options are cooking, stewing or
- Limit salt intake to 5 g per day. Usually
recommend food to cook without salt, and then add salt, stretching
This amount (about a coffee spoon) for the whole day.
- If you are overweight, you should reduce calories and volume.
portions. Need to lose weight, this is a very important point in the treatment
- Liquids consume no more than 1.5 liters per day.
- Dinner no later than 2-3 hours before bedtime.