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Cardiac asthma: symptoms and treatment, emergency

Cardiac asthma is an emergency that occurs when the left ventricle's ability to contract is impaired - acute left ventricular failure.

Normally, blood from the vessels of the pulmonary circulation (pulmonary veins) enters the left ventricle, and then, as a result of the contraction of its walls, is pushed into the aorta and enters the circulation.

If there is a decrease in the contractility of the myocardium of the left ventricle, it becomes unable to pump blood further down the chain. This leads to stagnation in the small circle - the vessels that pass through the lungs. As a result, they increase the pressure exerted by blood on the vascular wall, which leads to an increase in permeability.

Therefore, the liquid part of the blood “is forced through the vessel wall” and ends up in the lung tissue (in the interstitial space). The accumulation of fluid inside the lungs is accompanied by characteristic symptoms and leads to respiratory failure, as a result - oxygen starvation of the body. And in the absence of assistance, to the full "flooding" - pulmonary edema, which is fatal.

Thus, in cardiac asthma, there are 2 important pathogenetic aspects. The first is increased vascular pressure in the small circle, the second is ischemia (oxygen starvation) of the internal organs with the development of their insufficiency.

Content

Causes of cardiac asthma

Cardiac asthma what is it

The causes leading to the development of cardiac asthma are very diverse and multifaceted. Conventionally, they can be divided into four groups:

  1. Direct damage to myocardiocytes - smooth muscle cells that perform a contractile function in the heart;
  2. Increased load on the left ventricle, which eventually leads to its decompensation;
  3. The “wrong” rhythm of heart contraction, which reduces the quality of its work as the “pump” of the body;
  4. Increased blood flow to a weakened heart.

Thus, the ability of the heart muscle to reduce contraction:

При уменьшении численности функционирующих мышечных клеток – миокардиоцитов: 1. When reducing the number of functioning muscle cells - myocardiocytes:

  • Acute myocardial infarction of the left ventricle is the most common cause of cardiac asthma;
  • Acute myocarditis is an inflammation of the heart muscle, usually developing after past infectious diseases (most often after the flu);
  • Atherosclerotic cardiosclerosis is the deposition of plaques from “harmful” cholesterol on the vessels that feed the heart (coronary arteries).

При увеличении нагрузки на левый желудочек, отмечающейся при: 2. With an increase in the load on the left ventricle, marked with:

  • the occurrence of strong resistance on the part of the vessels into which blood is pumped, for example, in case of essential hypertension;
  • blood stasis inside the leftmost ventricle - heart defects (mitral stenosis, aortic insufficiency), interventricular septal injury, ventricular tumor, large intraventricular thrombus;
  • an increase in blood flow from the pulmonary vessels due to edema in pneumonia, especially in combination with a weak heart in patients with ischemic myocardial disease;
  • increasing blood volume in the body, such as fluid retention in kidney diseases, as well as large amounts of intravenous fluids (therefore, during detoxification therapy, it is important to calculate its adequate volume, for fear of overhydration).

Самые частые нарушения ритма сердца, сердечной астмой — это урежение или учащение сердечных сокращений (бради- и тахиаритмии как желудочкового, так и предсердного происхождения). 3. The most frequent cardiac arrhythmia, cardiac asthma, is a reduction or an increase in heart rate (brady and tachyarrhythmias of both ventricular and atrial origin).

Данная группа причинных факторов является сочетанной, т.е. 4. This group of causal factors is combined, i.e. on chronic cardiac patients with increased physical and emotional stress, being in a horizontal position.

This can increase blood flow to the heart and provoke cardiac asthma with heart failure and weak myocardium.

Heart Asthma Symptoms

Heart Asthma Symptoms

Symptoms of cardiac asthma may appear several days before the onset of an attack, in the form of a slight cough and shortness of breath. These are non-specific predictors that should be addressed in the presence of causative diseases. But in order to develop an acute condition, the action of provoking factors is necessary.

These include:

  • exercise stress;
  • nervous tension;
  • change of body position.

The attack of cardiac asthma begins abruptly, more often at night, in a supine position. The first symptoms are feeling short of breath and shortness of breath. The patient wakes up in a panic, feels the fear of death, scared and excited.

He suffers from suffocation, which he is trying to overcome while sitting - it is easier to inhale and exhale due to the work of additional muscles of the chest. In addition, when lying down, there is a significant increase in shortness of breath. The observed forced position in cardiac asthma is called orthopnea. The duration of the phases of respiration also changes. So, the inhalation is difficult, and the exhalation is extended.

A dry cough appears, then it becomes wet. Coughing does not bring relief to the patient. It appears reflexively to irritate the swollen mucous membrane of the bronchi and not to the presence of pathogenic agents.

After some time, the sputum acquires a foamy character, becomes pale pink due to blood cells from the injured and vessels getting into it (microtrauma is a result of increased pressure as a result of cough).

In severe cases, frothy sputum is also excreted through the nose.

symptoms of an asthma attack The specific symptoms of an attack of cardiac asthma - the appearance of wheezing, which can be heard at a distance, indicate a worsening of the situation and the beginning pulmonary edema. At this time, the patient requires emergency medical care, because acute hypoxia progressively increases.

The patient's skin is pale, fingers, ears and tip of the nose with a bluish tint (cyanotic), a large amount of cold sweat is released (a sign of dysfunction of the autonomic nervous system).

Blood pressure can be normal, high or low - it depends on the cause of the attack. However, its level is important to consider when conducting therapy, since some drugs used to relieve an attack increase the pressure. At this time, a rapid pulse is determined, up to 150 beats per minute.

Increased pulse is a compensatory response aimed at reducing the degree of organ ischemia. It develops as a result of a decrease in the partial pressure of oxygen in the blood and subsequent stimulation on this background of the medulla. It is the center of regulation of cardiac activity.

Diagnosis of the disease

Diagnosis is based on an objective examination of the patient. The basic criteria are the identification of the characteristic posture (orthopnea), shortness of breath, pallor of the skin, the release of foamy sputum.

It is very important for patients with cardiac asthma and their relatives to know how to detect the presence of shortness of breath. We describe this technique. A man’s hand is placed on his stomach and marked for 60 seconds. During this time interval, the number of perfect respiratory movements is counted (1 movement is inhale + exhalation). The norm is 16 per minute. They say about shortness of breath when their number is increased to 20 or more times.

The described technique helps to distinguish and simulate patients who artificially speed up breathing. To identify such people, they should not be told what purpose the hand is placed on the stomach, and they will not know that they are counting their breath.

The appearance of shortness of breath and difficulty in breathing makes it necessary to conduct a differential diagnosis of cardiac and bronchial asthma. The link with allergies, the predominant difficulty of exhalation (expiratory character of dyspnea), more pronounced dry wheezing when listening to the lungs (auscultation) will indicate bronchial asthma.

During an attack of bronchial obstruction, a person rests his hands on the headboard, handrails, in order to use as many auxiliary muscles as possible to relieve exhalation.

Usually, in cardiac asthma, a scanty at first auscultatory picture is combined with a severe general condition. With the development of circulatory disorders appear moist rales, detected first in the lower sections, and then over the entire surface of the lungs. Rattles in the formation of pulmonary edema become large-bubble and audible at a distance, so the people around them can hear them.

If the ambulance was not called earlier, then at this stage you should immediately call the emergency number.

When listening to the heart, additional noises, complex rhythm disturbances (gallop rhythm) are detected. Confirm an attack data ECG, Doppler, X-ray, ultrasound of the heart. These studies are carried out in stationary conditions after the patient is hospitalized.

Treatment of cardiac asthma

Treatment of cardiac asthma

Acute heart failure requires an immediate response in the face of a serious threat to human life. If symptoms characteristic of cardiac asthma are suspected, treatment should be started on site.

The patient is non-transportable until the attack is removed from the state. After improving the condition, hospitalization and additional therapeutic correction are required.

Before the arrival of doctors, the following medical measures can and should be done to help reduce the burden on the heart:

  • comfortably seat the patient, the legs should be lowered;
  • immerse the feet in hot water to dilate the blood vessels and retain blood in the vessels of the lower extremities;
  • put a harness on the upper thighs, over the clothes. This measure will also hold blood in the lower limbs and reduce blood flow to the heart. But the duration of application of the harnesses should not exceed 20 minutes, i.e. before the arrival of the ambulance;
  • In extreme cases, if medical assistance is not available, you need to make a bloodletting from the cubital vein in the amount of 300-500 ml, with observance of asepsis, and give 1-2 tablets of nitroglycerin under the tongue, and with increased blood pressure, add 1 tablet of corinfar (nifedipine, which dilates blood vessels ) inside without chewing. Bleeding is a measure from the past, therefore in modern conditions of the hospital is not performed. It is resorted to only if it is impossible to provide qualified assistance, i.e. . how to measure despair .

Medical impact is to eliminate the cause of cardiac asthma. Treatment begins to be carried out by ambulance doctors, and further continues by the attending physician in the hospital.

Emergency care for cardiac asthma

Emergency care for cardiac asthma:

  1. The elevated position of the head in the prone position, or the patient can be seated, especially with pulmonary edema. If a person has low blood pressure, these actions are not performed to prevent critical cerebral ischemia;
  2. Inhalation of oxygen with alcohol vapors to eliminate foaming, through a mask or nasal catheter (ethyl alcohol is an officially recognized defoamer);
  3. Nitroglycerin is used under the tongue, to expand the coronary vessels and relieve stress from the heart (administered intravenously for myocardial infarction, in other cases - under the tongue);
  4. A universal remedy is furosemide - it dilates the veins and due to this provides quick unloading of the myocardium, which is then enhanced by diuretic action;
  5. At high pressure, apply Corinfar (nifedipine) tablets inside;
  6. With a strong psychomotor agitation, severe shortness of breath, it is imperative to use morphine, which also provides effective pain relief. This drug affects the center of respiration, reducing the pathological frequency of respiratory movements, which can not compensate for the developing ischemia, and brings only harm to the body;
  7. In violation of the rhythm of the heart used antiarrhythmic drugs;
  8. With improved hemodynamic parameters, but with preservation of signs of pulmonary edema, hormones (prednisone) are used. They reduce the permeability of the vascular wall and prevent the exit of plasma into the interstitium;
  9. If poorly treatable pulmonary edema develops, heparin is administered to correct microcirculation and prevent thrombosis;
  10. When asthma is combined with cardiogenic shock and a decrease in pressure, substances that have a pressure effect are injected intravenously, dopamine, noradrenaline (they increase pressure due to a direct effect on the vessels).

Forecast

Like any emergency, cardiac asthma is life threatening. Favorable outcome depends on the early detection and rapid onset of treatment, as well as on the severity of the cause of the seizure.

Without treatment, cardiac asthma leads to pulmonary edema - a condition that leads to the death of the patient. The characteristic symptoms preceding such a state, we described above.

Preventing Cardiac Asthma

Preventing Cardiac Asthma

Prevention measures for cardiac asthma are aimed at adequate treatment of the initial diseases that trigger the development of an attack. It is recommended to avoid conditions leading to an increased load on the heart in all patients with pathologies of the heart, increased blood pressure, weakened cardiac muscle during coronary disease:

  • physical and emotional stress;
  • hypothermia;
  • SARS diseases and pneumonia (treatment should begin immediately - with the slightest increase in temperature).

The load on the heart can be reduced as a result of monitoring the amount of fluid consumed, as well as salt, which contributes to water retention in tissues. The volume of fluid per day - no more than 2 liters, taking into account water and liquid food.

Previously, it was recommended to limit the salt to 3-5 grams, while taking into account that there is a lot of it in some finished products (for example, in black bread). At the present time, it is generally necessary to refuse dosalivaniya. The physiological norm of sodium and chlorine (the constituent chemical elements of table salt) is contained in vegetables and fruits.

It is recommended to sleep with elevation of the head (they leave this measure when adequate supportive therapy is selected). Measure blood pressure regularly. They improve blood circulation by walking, moderate exercise in the form of walking, exercising on a stationary bike and swimming.

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