Cardiac asthma - Causes, Symptoms and Treatment .MF .
Causes of cardiac asthma
Symptoms Diagnosis Treatment
Complications and prognosis
In humans, the blood supply of all organs and systems at the expense of small and large circulation.Small circle covers the inflow of venous blood from the right ventricle to the lungs, saturate it with oxygen in the pulmonary alveoli and transport of oxygenated blood for the pulmonary veins to the left atrium.Then the blood comes through the left ventricle into the aorta, arteries is carried on all organs, providing a flow of oxygen in them, and after the gas exchange in the tissues of oxygen-depleted blood through the system of the vena cava enters the right atrium - a large circulation.
If due to some reasons of the heart can not cope with the pumping of blood, there is a stagnation of blood in the organs of the large and small circulation.Violation of the left heart contractility, as well as mechanical obstruction to blood flow in them lead to the fact that blood may not flow from the lungs to the
Increased blood supply vessels captured baroreceptors located in the vascular wall, and the signals are transmitted on this in the respiratory center of the nervous system.There comes a reflex center stimulation, increased respiratory rate, which clinically manifested by shortness of breath and attacks of breathlessness.These processes are characteristic of this clinical syndrome as cardiac asthma.
Cardiac asthma - is a manifestation of acute left ventricular failure, which is characterized by stagnation of venous blood vessels in the lung tissue and is expressed in clinically severe attacks of breathlessness and / or suffocation.Sometimes, in the absence of therapeutic interventions cardiac asthma may go into cardiogenic (heart), pulmonary edema, due to exceeding the critical level of pressure in the pulmonary capillaries, propotevanie liquid part of the blood into the alveoli (pulmonary "bubbles"), followed by the foaming of the liquid jet of air which passes during breathing.
itself cardiac asthma is life threatening condition is not even able to arrest the self, but sometimes for a few minutes can lead to pulmonary edema, which is a threat to the life of the patient.
The figure shows a violation of the contractility of the myocardium, in which the proper amount of blood can not be disposed in the aorta (2), in contrast to the normal working of the heart (1), thereby increasing the pressure in the left ventricle and then to the leftatrium and pulmonary veins.
Causes of cardiac asthma
Causes of cardiac asthma can be any cardiac disease, which has its outcome in heart failure.Such diseases are as follows:
- heart defects, most often mitral valve stenosis
heart disease - acute myocardial
myocardium - myocardial infarction
- left ventricular aneurysm
- arterial hypertension, hypertensive crisis
- paroxysm of atrial fibrillation
- myocarditis,postmiokarditichesky cardio
- cardiomyopathy (hypertrophic, dilated, restrictive)
- intracardiac thrombi
- heart tumor (myxoma)
- acute and chronic glomerulonephritis (due to hypertension development)
The figure shows that the myocardial hypertrophyventricular volume is reduced, resulting in blood "stagnated" in the atria and vessels flowing into the atrium, in particular in the pulmonary veins.
triggering factor capable of provoking an increase in pressure in the pulmonary capillaries, are excessive psycho-emotional or physical load in patients with the above diseases.Also cardiac asthma episodes can occur during pregnancy on the background of existing heart disease, with fever in patients with chronic heart failure patients.
symptoms of cardiac asthma
Forerunners cardiac asthma can occur even in two - three days before the onset of the episode.The patient on the background of increased load bother weakness, fatigue, chest tightness, inability to deep breath in deeply.Asthma attack more often appears during the night due to the fact that in the horizontal position in the pulmonary blood flow slows and venous return to the heart increases.The patient can not get to sleep or waking up sharply from what feels choking, can not breathe deeply.Increasing frequency of respiratory movements, there is a compulsive dry cough, sometimes with scanty sputum or blood-streaked.Exude a sticky cold sweat, the patient can feel the fear of death.Develops blue triangle and the nasolabial skin fingers (akrotsianoz).The patient tends to take the position orthopnea - sitting with a support on the hands, as in a vertical position venous return to the heart is slightly reduced, which can cause temporary relief.
patient must remember that the best solution in this situation will cause a brigade ambulance, because only a doctor can compare the presenting symptoms and the need for hospitalization with medical - diagnostic purposes.
diagnosis of cardiac asthma
diagnosis of cardiac asthma can be assumed even during the clinical examination of the patient.In support of his show typical complaints of shortness of breath and asthma in a patient with existing cardiac disease.In rare instances, an attack of cardiac asthma can occur suddenly, amid the complete physical well-being as a result of the development of painless form of myocardial infarction, left ventricular aneurysm rupture, hypertensive crisis without prior subjective sensations.
When auscultation of the chest muffled heart sounds are determined, the emphasis II tone of the aorta at the point of listening, spasmodic contraction of the heart, abnormal tones and noises typical of heart disease, or finely dry rales in the lower regions of the lungs or all lung fields.When palpation of the abdominal cavity can be observed enlarged liver, indicating stagnation of blood in the organs of the systemic circulation.Blood pressure can be increased, decreased, or remain in the normal range.The appearance of a wet cough with frothy sputum, wet rales in the lungs indicates the development of pulmonary edema, and a sharp decrease in blood pressure - on the collapse of development that requires urgent remedial measures in a Cardiac Intensive Care Unit.
From additional methods of examination should be used:
- ECG reveals signs of overload of the left ventricle (the displacement of the heart's electrical axis to the left, a tall R wave in the left precordial leads - V1 - 2, conduction disturbances (total or partial blockade) on the leftbundle branch block), signs of myocardial ischemia or myocardial infarction, signs of heart disease (P wave changes characteristic of the overload of the right or left atrium, ventricular myocardial hypertrophy, etc.).
- chest organ cells showing signs of increased pulmonary pattern, caused by a vascular component, as well as the expansion of the shadow of the heart in diameter.
these activities at the reception department of cardiology hospital enough to hospitalize a patient as soon as possible with cardiac asthma in the department for medical - diagnostic measures.In the department the patient is conducted further investigation, including the following diagnostic methods:
- echocardiogram (ultrasound of the heart) allows you to set a more accurate diagnosis - heart disease, acute or myocardial infarction, left ventricular aneurysm, cardiomyopathy and other diseases that cause contractiledysfunction of the left ventricle.Also revealed signs of hypo- or akinesia (loss or absence of myocardial contraction in certain areas of the heart), decreased stroke volume and left ventricular ejection fraction, increased pressure in the left atrium and pulmonary veins (pulmonary hypertension).
- according to indications can be assigned MRI heart to clarify the location and degree of damage to the heart muscle
- in stopping life-threatening symptoms appointed CAG (coronary angiography) urgently in patients with acute myocardial infarction (no later than six hours from the start of development) torestoration of blood flow through the occluded coronary artery and in a planned manner to persons with coronary heart disease for a decision on the appropriateness of stenting of coronary arteries.
physician should be aware of how to distinguish between cardiac and asthma.In bronchial asthma complicated breath (dyspnea expiratory character), wheezing breath, the patient can not cough up trudnootdelyaemoy glassy, viscous phlegm in the lungs auscultated dry wheezing.When cardiac asthma difficult to breath (dyspnea inspiratory character), the patient can not breathe deeply, noisy breath, worried about hacking dry cough, sputum no or scant amount streaked with blood, the lungs are listened finely or dry wheezing.
Differential diagnosis is important because treatment strategy for these diseases is significantly different.Purpose of diuretic drugs is justified in cardiac asthma, while bronchial asthma, their use may significantly heavier patient condition.This is due to the fact that the diuretic is output from the body fluid, sputum bronchial therefore becomes more dense and viscous, finally clogging them lumen.
treatment of cardiac asthma
treatment of cardiac asthma is conducted in the cardiology or therapeutic hospital, if necessary - in the intensive care unit.
Prehospital, waiting for the arrival brigade ambulance, the patient or his family may alleviate the condition as follows.The patient should take a comfortable position in bed, sitting with downcast feet, measure the blood pressure of a home tonometer, open the window for fresh air, under the tongue must be put and sucked 1 - 2 tablets of nitroglycerin every five minutes for 15 minutes under pressure control (ifpressure below 90/60 mm Hg, can not take nitroglycerin) for the expansion of the pulmonary and coronary vessels, it is necessary to arrange the hot foot bath, dropping into a bowl with hot water foot and lower leg.This is to ensure that the leg veins and widened to accommodate a greater amount of blood, thus reducing blood flow to the heart.
Upon arrival, the doctor, after transporting the patient to the hospital and admission is conducted therapy the following groups of drugs:
- nitroglycerin intravenously reduces venous blood flow to the heart,
- Lasix or furosemide intravenously takes fluid from the body, helping to decrease blood volume, andpulmonary vessels as well.These drugs, as well as nitroglycerin, contribute to lower blood pressure, so a low level of blood pressure in the patient's treatment should be carried out with agents that increase vascular tone and blood pressure, such as mezatonom, dopamine and other cardiotonic drugs,
- strofantin intravenously applicableto improve the contractility of the heart muscle, and for the recovery of cardiac arrhythmias, for example, in a paroxysm of atrial fibrillation,
- aminophylline intravenously is antispasmodic, relaxes smooth muscles, including those in the vascular wall, it is necessary to improve pulmonary blood flow,
- can be assignednarcotic analgesics (morphine derivatives) for the relief of pain in heart attacks and to reduce the activity of the respiratory center, as well as neuroleptics (droperidol) to eliminate panic attacks, fear of death and prevention of respiratory depression,
- treatment of the underlying disease (hypertension correction, arrhythmias, treatmentmyocardial infarction, heart disease, and so on. d.)
Lifestyle with cardiac asthma
For the patient who has had bouts of cardiac asthma, relevant activities aimed at the prevention of recurrent attacks.These include:
- elimination of stress, limiting significant physical exertion
- proper organization of the daily routine with a sufficient duration night's sleep (at least 8 hours) and rest in the daytime
- the organization of nutrition with the exception of alcohol, coffee, cigarettes, greasy, spicy, fried food;limited use of salt, fluid intake, animal fat, fatty meats, fish and poultry;with a high content in the diet of fermented milk products and fresh fruits, vegetables, cereals, vegetable oils as a source of vegetable protein, carbohydrates and fats
- regular intake of prescribed drugs your doctor, timely visit to the attending
doctor - patient performance in the absence of disability on the underlying disease canbe restored after discharge from the hospital according to the usual terms of temporary incapacity Sickness.
Complications of cardiac asthma
Without treatment, a complication of cardiac asthma attack is to move it to the stage of alveolar pulmonary edema, which refers to the life-threatening conditions.
Prevention of edema is the timely provision of emergency care and hospitalization in the hospital with a thorough examination and treatment of the underlying disease.
Without care prognosis may be unfavorable, since the high probability of a transition in cardiac asthma pulmonary edema, which can lead to death.
If successful, cupping and regular intake of medication prescribed on the underlying disease in order to reduce the progression of venous congestion in the lungs, the prognosis is favorable.
therapists Sazykina OJ