First Aid for Heart Asthma
Author Ольга Кияница
Cardiac asthma (SA) is a paroxysmal dyspnea that occurs on the background of heart failure, which is in the stage of decompensation. Its appearance indicates pulmonary edema, which is a severe disorder that should be treated promptly.
Cardiac asthma and bronchial asthma are not the same thing. The clinical picture of these diseases is similar, but the process of occurrence is different, so their treatment is also different.
In some cases, cardiac asthma is acute, according to the type of acute heart failure. In such cases, immediate medical attention is required, before the arrival of which initial emergency actions can be taken.
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The difference between cardiac asthma and bronchial
Despite the fact that many patients experience similar symptoms in bronchial asthma and cardiac, the development mechanism of these diseases is different. While the pathophysiology of bronchial asthma is based on inflammation and narrowing of the airways, the symptoms of cardiac asthma depend on the course of the underlying disease, heart failure.
Heart failure is a condition in which the heart does not pump blood in sufficient quantities. The disease can sometimes mimic bronchial asthma, therefore patients are called cardiac asthma. Inhalation of air in cardiac asthma is hampered not because of the narrowing of the airways and inflammation, but because of the accumulation of fluid in the lungs.When the heart is not working properly, fluid accumulates in the vessels and gradually fills the lungs. As a result, there is wheezing in the lungs.
Sometimes heart failure occurs due to the narrowing of the arteries that supply blood to the heart. In other cases, high blood pressure for many years leads to damage to the heart and poor heart function. As a result, dilated, restrictive or hypertrophic cardiomyopathy develops.
Viral infections, drug abuse and alcohol abuse can cause damage to the heart muscle and symptoms of congestive heart failure.
Finally, a number of other diseases can have a negative effect on the heart and cause damage to the heart muscle. In particular, problems may arise due to valvular, thyroid, chronic kidney disease or diabetes.
Sometimes the treatment can change the course of the underlying disease, with the result that the patient’s condition improves.
Principles for the determination of cardiac asthma
For the correct conduct of the first emergency care for heart failure, you need to properly assess the condition of the patient. In particular, cardiac asthma symptoms are important.
In addition to asthma symptoms (wheezing, shortness of breath and coughing), cardiac asthma can cause:
- Fluid retention in the ankles and feet of the lower extremities, called edema.
- Patients may notice weight gain due to fluid retention.
- Patients with heart failure report other symptoms that can also be determined by poorly controlled bronchial asthma (fatigue, weakness, and dizziness).
It is important to know that about a third of all elderly patients with congestive heart failure complain of wheezing.
After determining the signs of the disease, additional diagnostic methods are carried out, if possible.
In most cases, the diagnosis is clinical and is made by a cardiologist or attending physician. If the doctor suspects that the symptoms are not caused by bronchial asthma, additional tests may be performed to look for congestive heart failure. In particular, carried out:
- Complete blood count is a blood test that most often reflects the inflammatory reactions that take place in the body, therefore, they are not indicative of heart failure.
- Echocardiography is an ultrasound scan of the heart that shows how well the heart works, in particular, the ejection fraction is evaluated.
- Electrocardiography - assessment of the electrical conductivity of the heart, which allows you to quickly identify acute heart problems and establish damage to the myocardium.
- MRI of the heart - examinations are performed to determine the pathological deposits in the blood vessels, including those that feed the heart.
Emergency care in a seizure
When the symptoms are very serious, it can lead to hypoxemia or a lack of oxygen in the blood. Ultimately, a patient with cardiac asthma may need cardiopulmonary resuscitation, intubation, or being in an intensive care unit. If a patient with cardiac asthma experiences a sharp and acute decrease in blood flow through the development of acute myocardial infarction, then there is a threat to life.
There is the following algorithm for emergency treatment of cardiac asthma:
- Seat the patient near a window or in a room where there is free air access.
- To free the patient from the constraining clothes.
- Inspect the oral cavity for foam or mucus.
- Measure blood pressure and record the indicator to provide it to the ambulance team.
- In the presence of nitroglycerin, one tablet is placed under the tongue and held until complete dissolution.Nitroglycerin can be replaced with validol.
- Tablets to improve the blood supply to the myocardium (validol and nitroglycerin) can take no more than two times with an interval of five minutes.
- The development of pulmonary edema can be prevented if venous strands (on the shoulder and thigh) are applied to the arms and legs. If you do not have this medical device, you can use elastic bandages or, in extreme cases, nylon stockings.
The harnesses are first superimposed only on the arm and legs, and then every 15 minutes one harness is shifted to the free limb and in a circle. If the tourniquet is applied correctly, then the limb will turn blue below the place of compression, but the pulse will be felt at this.
8. Sometimes the imposition of harnesses is impossible, then the legs may be lowered into a bowl of warm water or lined with hot water bottles. This method is less effective than the application of harnesses, but it can still help reduce the burden on the heart.
The above actions are performed before the arrival of the ambulance. At the same time, even if an attack of cardiac asthma was stopped, it is still most reasonable to send the patient to the hospital, since everything can happen again.Also, failure to comply with medical recommendations can lead to the development of complications and even death of the patient.
The main treatment is to eliminate the underlying heart disease. If symptoms are caused by poor heart function, treatment focuses on improving the pumping function of the organ. In particular, are used:
- Diuretics - drugs stimulate the urinary function of the kidneys, which helps to remove fluid from the body.
- ACE inhibitors - reduce the load on the heart due to the hypotensive effect.
- Nitrates - contribute to vasodilation and reduce the load on the heart.
In the short term, the doctor may prescribe short-acting beta-agonists (beta-stimulants) that can improve the patient's well-being. In addition, if there is hypoxia, manifested by dizziness and tachycardia, oxygen is used. Patients with cardiac asthma and symptoms such as shortness of breath generally respond quickly to beta-agonists.
In some cases, systemic steroids can be used that are effective in the absence of a patient's response to diuretics. If there is a potential concern that there is asthma or any component of reactive respiratory disease or COPD, antibiotics are used additionally.
If the doctor suspects that wheezing is associated with cardiac asthma, then bronchial asthma is most likely excluded.That is why it is important to consult a doctor with any symptoms that seem to be asthma. One important principle that is practiced in medicine is that not all that wheezes is bronchial asthma. Therefore, only a qualified doctor can determine which symptoms relate to which disease.
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