Canadian Pharmacy: Cardiac Asthma

Cardiac asthma is a condition in which a patient experiences asthma attack, which can last from several minutes to several days. This condition poses threat to human’s life. Cardiac asthma may occur in presence of such diseases as cardiac abnormalities, cardiosclerosis, myocardial infarction and other diseases that are associated with cardiac insufficiency.

The main cardiac asthma symptom is dyspnea, which causes a feeling of tightness in the chest. During attack, patient experiences feeling of fear and intensively tries to listen and understand what is happening in his body.

Cardiac asthma diagnostics is comparatively simple for young people and can be very complicated at elderly people. In latter case, differential diagnostics is required. It is performed in order to identify cardiac asthma symptoms and define what kind of asthma is present at the patient (bronchial or cardiac). Such diagnostics is versatile and complex.

Emergency medical care is very important, which in most cases is carried out on-site. Purpose of medical emergency care is to reduce blood flow in pulmonary circulation and heart.

To solve this problem, doctors make some injections, bloodletting, and use of leeches is possible. Often there is a need for patient’s hospitalization after first aid. Emergency care is a whole complex of measures.

In hospital for patients with mitral stenosis surgical removal of all cardiac asthma symptoms is possible. This is done simultaneously with surgical treatment of the heart disease (mitral stenosis).

Preventive measures, aimed precisely at preventing a cardiac asthma attack, are difficult to determine. This is due to the fact that major preventive measures, aimed at preventing cardiovascular diseases, are also directed to preventing the development of each of them (including cardiac asthma).

Facts about Cardiac Asthma

Cardiac asthma is an independent disease. It is not true. Cardiac asthma usually develops as a complication of other medical conditions. It can be congenital and acquired heart diseases, hypertension, cardiosclerosis or myocardial infarction.

Cardiac asthma usually occurs at night. It leads to an awakening patient with a feeling of acute shortage of air and tightness in the chest. Common phenomena at cardiac asthma are dyspnea and appearance of a dry cough. A patient usually begins to feel anxiety and fear. His face is covered with sweat. If cardiac asthma occurs during the day, then it is caused in most cases angina attack, a sudden increase in blood pressure or emotional and physical activity. Before the actual occurrence of cardiac asthma patient may complain of palpitations and tightness in the chest. Still, it is worth remembering that cardiac asthma in most cases develops during the night.

Dyspnea is the main symptom of cardiac asthma. Dyspnea is paroxysmal in nature. Noisy prolonged inhale dominates. During this attack, a patient usually begins to breathe through the mouth. At cardiac asthma attack appeared during night patients cannot continue to stay in lying position – they take sitting or standing position. This happens because vertical position of the body contributes to dyspnea reduction. Often patient, who is having cardiac asthma, is forced to go to the window, which is caused by a desire to get some fresh air. Patient experiences severe difficulties with pronouncing words which gives rise to fear. This is reflected in his facial expressions – on patient’s face you can see fear and tension.

Cardiac asthma is the result of cardiac changes. Development of cardiac asthma is caused by left ventricular cardiac insufficiency or mitral stenosis. Mitral stenosis is a narrowing of left atrioventricular opening. Thus, cardiac asthma is the result of deep organic changes of the myocardium (heart muscle). These changes primarily affect left ventricle of the heart.

The basis of suffocation attacks appearance at people with cardiac diseases is left ventricle weakness. In this case, right ventricle remains functioning. As a result, in pulmonary circulation reflexively hypertension appears. This hypertension is also known as pulmonary and contributes to a sharp increase in blood amount and decrease in pulmonary ventilation volume. The first (rapid increase in blood amount) is also accompanied by an overflow of bronchial veins and sustained blood flow in pulmonary capillaries. All this leads to the second (decrease of ventilation) and leads to disruption of gas exchange.

Directly provoking asthma attack cause is excessive irritation of respiratory center in the brain. This occurs because of increased carbon dioxide in the blood and decreased oxygen content. Respiratory lung surface decreases due to increased permeability of capillary walls of pulmonary circulation. As a result, fluid accumulates in alveoli cavities, which, naturally, makes the gas exchange more difficult.

Cardiac asthma is the beginning of pulmonary edema development. The latter may occur due to an accumulation of a very large amount of liquid in alveoli cavity, resulting in sharp difficulties in lung functioning. Excessively accumulated fluid in alveoli may begin to flow into bronchi, which leads to the emergence of severe forms of pulmonary edema. To avoid this, immediately after onset of cardiac asthma attack patient should direct all his efforts to prevent this complication.

Cardiac asthma attack duration is small. Not quite right, because the duration of attack can be counted in minutes and hours as well as even days. The cardiac asthma attack can lead to patient’s death if he failed to prevent pulmonary edema in time.

Diagnostics of cardiac asthma is not difficult. This applies only to diagnostics of cardiac asthma in young people when asthma attacks are of typical character. At elderly people, diagnostics of cardiac asthma is not so easy. This occurs due to the fact that at elderly people cardiac asthma is often observed on the background of pulmonary emphysema or chronic bronchitis, which smooth immediate clinical manifestations of cardiac asthma. In this case, diagnostics should have a differential character which will determine what kind of asthma a patient has – bronchial or cardiac.

However, there are cases when such diagnostics is also not effective. It does not allow to be confident in the correctness of asthma recognition. It concerns primarily those patients at which it is very difficult to differentiate bronchial asthma from cardiac. This applies to cases when asthma is accompanied by cardiac insufficiency and pulmonary emphysema, cardiac asthma, in this case, is characterized by muscle spasms of small bronchi. In this case, we are talking about the so-called «mixed asthma». In order to make a diagnosis in such case, it is necessary to conduct a thorough and comprehensive examination, after which it is desirable to keep patient under prolonged clinical observation.

In case of emergency care, it is necessary to solve several problems. There are two of them. The first thing doctor needs to do is to contribute to a reduction of circulated blood amount in pulmonary circulation by reducing its flow. The second – is to try to solve the same problem, only by increasing blood outflow from pulmonary circulation.

To solve the first problem, it is necessary to do the following. First, a patient must take a sitting position. This position can be attributed to a protective act because it helps to reduce blood flow in the pulmonary circulation and right ventricle of the heart. Sitting position leads to slowing blood flow in veins of lower extremities, which leads to blood flow limitation. Applying tourniquets on lower limbs may to a large extent contribute to blood flow reduction. Time of staying with tourniquets varies between one and one and a half hours. In severe cases of cardiac asthma, it is possible to apply tourniquets not only on lower limbs but also on upper. If a cardiac asthma attack is mild, it is possible to use dry cans, which are set on the thorax. Hot foot bath is also used. At severe cardiac asthma, characterized by a long-lasting attack, leeches can be used. In this case, on the liver area, doctors put from twelve to fifteen leeches. Bloodletting from a cubital vein (from 400 to 500 ml) is also possible. If there are neuro-vascular disorders, patients receive aminophylline, caffeine, cordiamin, camphor.

To solve the second problem, the following measures are applied. Patients get oxygen inhalations, intravenously administered aminophylline, strophanthin, neriolin or other cardiovascular drugs, which are dilute in 0,85% sodium chloride solution or glucose solution. Subcutaneous administration of morphine or lobelia is possible. Purpose of the latter is to regulate breathing act. These drugs act on respiratory center of the brain.

Immediate measures at cardiac asthma should be carried out comprehensively. Their implementation is recommended already on-site. It is very important to help a patient to achieve mental and physical calmness. If performing the whole complex of measures for emergency care at cardiac asthma is not possible, then only a part of these measures is carried out. Since there is no danger to life anymore, a patient is taken to the hospital. It requires certain precautions, in particular, use of wheelbarrow, possible injections of caffeine and camphor during their journey to the hospital. For this measures, a patient should be provided with comfortable riding. At the hospital, a patient is assigned a range of therapeutic interventions. Proper care, adherence to certain diet and other measures are necessary.

Cardiac asthma treatment is carried out conservatively. In most cases, patient eliminates attack by using conservative methods. However, for example, in the case where the patient mitral stenosis (a type of heart disease), asthma attacks possible withdrawal (due to cardiac asthma) by direct surgical treatment of mitral stenosis.

Cardiac asthma prevention is similar to other cardiovascular diseases. Of course, everyone cannot know what preventive measures should be carried out to avoid each specific cardiovascular system disease. Not everyone knows about the existence of this kind of suffocation attacks as cardiac asthma. But absolutely everyone must take good care of his health and carry out the following general preventive measures (a complex of preventive measures).

  • First, reduction of mental stress – they most often cause diseases of cardiovascular system.
  • Second, active lifestyle. It is about providing your body with «muscle joy» (expression belongs to I. P. Pavlov).
  • Third, good rest.
  • Fourth, good nutrition and avoidance of harmful habits.
  • Fifth, recurring examinations by a cardiologist for prevention.

This is quite a simple set of measures offered by Canadian Pharmacy, that can set each person on health and virtually eliminate the possibility of any cardiovascular diseases, or at least help to carry out successful management of cardiac asthma and other diseases.