Cardiac asthma – the sharp left ventricular insufficiency caused by stagnation of blood in a small circle of blood circulation and interstitsialny hypostasis of lungs. Attacks of cardiac asthma are followed by feeling of an acute shortage of air, , hoarse dry cough, cyanosis of the person, tachycardia, increase diastolic HELL, excitement, fear of death. The diagnosis of cardiac asthma is based on assessment of clinical symptoms, these survey, the anamnesis, a X-ray analysis of a thorax, the ECG. The attack of cardiac asthma is stopped by means of nitroglycerine, narcotic analgetics, hypotensive and diuretic medicines, bloodletting, imposing of venous plaits on an extremity, a kislorodoterapiya.
Cardiac (kardialny) asthma – the clinical syndrome which is characterized by sudden attacks of the inspiratory short wind developing into suffocation. In cardiology cardiac asthma belongs to heavy manifestations of the sharp insufficiency of the left departments of heart complicating a current of a number of cardiovascular and other diseases. At cardiac asthma the sharp decrease in sokratitelny ability of a myocardium and stagnation of blood in system of a small circle of blood circulation leading to sharp violations of breath and blood circulation is noted. Cardiac asthma can precede development of alveolar hypostasis of the lungs (quite often lightning) which are often leading to a lethal outcome.
Reasons of cardiac asthma
Cardiac asthma can be connected with direct damage of heart or develop against the background of not cardiogenic diseases and states. Can be the reasons of cardiac asthma primary sharp or chronic (in an aggravation stage) left ventricular insufficiency. Cardiac asthma can complicate a current of the IBS various forms (including a sharp myocardial infarction, unstable stenocardia), a postinfarction and atherosclerotic cardiosclerosis, sharp myocarditis, a postnatal cardiomyopathy, heart aneurism. Paroksizmalny forms of arterial hypertension with high rises HELL and the excessive tension of a myocardium of the left ventricle, attacks of vibrating arrhythmia and trembling of auricles are potentially dangerous in the development plan for cardiac asthma.
Quite often lead dekompensirovanny mitralny and aortal heart diseases (a mitralny stenosis, aortal insufficiencies) connected with an obstacle for blood outflow to cardiac asthma. Violation of a blood-groove in the left departments of heart can be promoted by existence of large vnutripredserdny blood clot or intracavitary heart tumors - miksoma.
Infectious diseases (pneumonia), damage of kidneys (sharp glomerulonefrit), sharp violation of brain blood circulation can cause development of cardiac asthma. Inadequate physical activity, strong emotional pressure, a gipervolemiya (belong to the factors provoking emergence of an attack of cardiac asthma at intravenous administration of a large amount of liquid or its delay, fever, pregnancy), plentiful meal and liquids for the night, transition to horizontal position.
Pathogenesis of cardiac asthma
The mechanism of development of an attack of cardiac asthma is connected with the difficulty of intracardial haemo dynamics in the left departments of heart leading to an excess krovenapolneniye of pulmonary veins and capillaries and sudden increase in hydrostatic pressure in a small circle of blood circulation. Owing to increase in permeability of walls of capillaries there is an active exit of plasma in tissue of lungs (first of all in perivaskulyarny and peribronkhialny spaces) and development of interstitsialny hypostasis of lungs. It breaks ventilation of lungs and worsens normal gas exchange between alveoluses and blood.
A part in development of clinical symptoms of cardiac asthma is played by neuroreflex links of regulation of breath, a condition of brain blood circulation. The vegetative symptomatology accompanying an attack of cardiac asthma develops at excitement of the respiratory center as a result of violation of its blood supply or is reflex, in response to impulses from various centers of irritation (for example, from an aorta root).
Symptoms of cardiac asthma
The previous 2-3 days which appeared in short wind, constraint in breasts, a tussiculation at small physical activity or transition to horizontal position can be harbingers of an attack of cardiac asthma. Attacks of cardiac asthma are more often observed at night, during sleep owing to weakening of adrenergichesky regulation and increase in inflow of blood to system of a small circle in a prone position. In the afternoon the attack of cardiac asthma is usually connected with physical or psychological tension.
Usually attacks of cardiac asthma arise suddenly, forcing the patient to wake up from feeling of the acute shortage of air and increase of the short wind passing into suffocation and which is followed by hoarse dry cough (later - with small office of a transparent phlegm). During an attack of cardiac asthma it is difficult for patient to lie, it accepts the compelled vertical position: rises or sits down in beds, having lowered legs () down; breathes usually through a mouth, hardly speaks. The condition of the patient with cardiac asthma excited, uneasy, is followed by feeling of panic fear of death. At survey cyanosis in the field of a nasolabial triangle and nail phalanxes, tachycardia, increase diastolic HELL is observed. At an auskultation dry or poor melkopuzyrchaty rattles, mainly in the lower sites easy can be noted.
Duration of an attack of cardiac asthma can be of several minutes till several o'clock, the frequency and features of manifestation of attacks depend on specifics of the main disease. At a mitralny stenosis attacks of cardiac asthma are observed seldom as stagnation in capillaries and the venous course of a small circle of blood circulation is interfered by reflex narrowing pulmonary (Kitayev's reflex).
At development of right ventricular insufficiency attacks of cardiac asthma can disappear absolutely. Sometimes cardiac asthma is accompanied by a reflex bronchospasm with violation of bronchial passability that complicates differential diagnosis of a disease with bronchial asthma.
At a long and heavy attack of cardiac asthma "gray" cyanosis, cold sweat, swelling of cervical veins develops; pulse becomes threadlike, pressure falls, the patient feels sharp decline of forces. Transformation of cardiac asthma in alveolar hypostasis of lungs can suddenly happen or in the course of disease severity increase what emergence plentiful foamy testifies to, to impurity of blood of a phlegm, damp small - and srednepuzyrchaty rattles over all surface of lungs, heavy .
Diagnosis of cardiac asthma
For the correct purpose of medicinal therapy it is important to differentiate an attack of cardiac asthma from a suffocation attack at bronchial asthma, a sharp stenosis of a throat, from short wind at uraemia, a mediastinalny syndrome, a fit of hysteria. Assessment of clinical displays of cardiac asthma, data of objective survey, the anamnesis, a X-ray analysis of a thorax, the ECG help to establish the exact diagnosis.
Auskultation of heart during an attack of cardiac asthma is complicated because of existence of respiratory noise and rattles, but nevertheless allows to reveal dullness of warm tones, a gallop rhythm, accent of the II tone over a pulmonary trunk, and also symptoms of the main disease - violation of a rhythm of heart, insolvency of valves of heart and aorta, etc. Pulse, increase, and then decrease HELL is noted frequent, weak filling. When listening lungs rattles are defined single or scattered dry (sometimes single damp).
On the roentgenogram of a thorax at cardiac asthma signs of venous stagnation and a polnokroviya in a small circle, decrease in transparency of pulmonary fields, expansion and unsharpness of roots of lungs, emergence of the lines of Kerli testifying to interstitsialny hypostasis of lungs are noted. On the ECG during an attack of cardiac asthma decrease in amplitude of teeth and an interval of ST is observed, arrhythmias, signs of coronary insufficiency can be registered.
At the cardiac asthma proceeding with a reflex bronchospasm, abundance of the whistling rattles and the increased secretion of a phlegm for an exception of bronchial asthma consider age of the first display of a disease (at cardiac asthma – advanced age), absence at the sick allergologichesky anamnesis, chronic inflammatory diseases of easy and top airways, existence of sharp or chronic cardiovascular pathology.
Treatment of cardiac asthma
In spite of the fact that the attack of cardiac asthma can independently be stopped, in view of high risk of development of hypostasis of lungs and threat of life of the patient the emergency delivery of health care on the place is necessary. The held therapeutic events have to be directed to suppression of neuroreflex excitement of the respiratory center, decrease in emotional pressure and unloading of a small circle of blood circulation.
To facilitate a current of an attack of cardiac asthma, the patient needs to provide the maximum rest, a comfortable semi-sitting position with the lowered legs, to organize a hot foot bathtub. Nitroglycerine reception sublingual with repetitions or nifedipine with obligatory monitoring HELL before subjective simplification of a state is shown each 5-10 min.
At cardiac asthma with severe short wind and a pain syndrome narcotic analgetics are applied. In case of oppression of breath, a bronchospasm, chronic pulmonary heart, brain hypostasis, they can be replaced neyroleptanalgetiky - droperidoly.
Method of urgent unloading of a small circle of blood circulation at arterial hypertension and venous stagnation is bloodletting (300–500 ml of blood). In the absence of contraindications imposing on an extremity of the plaits which are squeezing veins and artificially creating venous stagnation on the periphery is possible (duration no more than 30 min. under control of arterial pulse). At cardiac asthma the long repeated inhalations of oxygen through ethyl alcohol (by means of nasal catheters or a mask, at hypostasis of lungs – IVL) promoting reduction of hypostasis of pulmonary fabric are shown.
At development of an attack of cardiac asthma correction HELL is carried out by hypotensive means and diuretic medicines (furosemide), Practically in all cases of cardiac asthma it is necessary in/in introduction of solutions of warm glycosides - a strofantin or digoxin. Eufillin can be effective at the mixed form of asthma warm and bronchial, at a mitralny stenosis due to expansion of coronary vessels and improvement of blood supply of a myocardium. At cardiac asthma with violation of a rhythm of warm activity electropulse therapy (defibrillation) is applied. After knocking over of an attack of cardiac asthma further treatment taking into account a cause of illness is carried out.
Forecast and prevention of cardiac asthma
The outcome of cardiac asthma substantially is defined by the main pathology leading to development of attacks of suffocation. In most cases forecast of cardiac asthma adverse; sometimes complex treatment of the main disease and strict observance by patients of the restrictive mode allow to warn repeated attacks, to maintain rather satisfactory condition and even working capacity for several years.
Prevention of cardiac asthma consists in timely and rational treatment of chronic IBS and heart failure, arterial hypertension, the prevention of infectious diseases, observance of the water-salt mode.