Cardiac asthma (Asthma cardiale, panting) is an attack of sudden shortness of breath due to acute failure of the left ventricle or left atrium of the heart.
Acute left ventricular failure can develop with hypertension, aortic heart defects, coronary insufficiency, myocardial infarction, nephritis, etc. In this case, the weakened left ventricle is not able to completely pump blood from the lungs into the aorta, while the right ventricle continues to pump it into the pulmonary circulation, which is full of blood. As a result, gas exchange in the lungs is disturbed , carbon dioxide accumulates in the blood , respiratory center irritation occurs and shortness of breath appears. Acute left atrial insufficiency with the development of cardiac asthma can occur with mitral stenosis (see Heart defects). Physical and mental stress, overflow of the gastrointestinal tract, etc. contribute to the development of cardiac asthma. Attacks of cardiac asthma more often occur at night. This is due to the horizontal position of the body, in which the blood flow to the heart increases, as well as an increase in the tonus of the vagus nerve during sleep, which causes a narrowing of the coronary arteries and a deterioration in the nutrition of the myocardium.
A patient who was in good condition during the day and could even perform light work, suddenly at night wakes up from a lack of air, sits down in bed. He has severe shortness of breath, weakness, cold sweat, anxiety. The skin is pale with a bluish tint. A cough appears with a discharge of light foamy sputum. When breathing is difficult, inhalation may be heard at a distance, bubbling in the chest, wheezing above the lungs , mainly wet, is heard . Heart sounds are muffled, above the pulmonary artery II tone is enhanced; sometimes a gallop rhythm appears (see Gallop rhythm). The pulse is frequent, weak filling. In severe cases, an attack of cardiac asthma ends with pulmonary edema (see). Differential diagnosis with bronchial asthma – see table.
Treating cardiac asthma requires quick action. With an attack of cardiac asthma, the patient should be comfortably seated in bed, lowering his legs. It is necessary to ensure an influx of fresh air (open the window), to breathe in oxygen, alcohol passed through 70%, poured into the humidifier of the oxygen system. In the absence of a humidifier with alcohol, gauze is wetted, stretched on the mouthpiece of an oxygen pillow. Heaters are applied to the arms and legs. 2-3 ml of a 20% camphor solution are injected subcutaneously; 1 ml of 1% morphine solution together with 0.5 ml of 0.1% atropine solution. If the patient does not get permanently preparations of digitalis, intravenous slow strophanthin (0.5- 0.7 ml of 0.05% solution) or Korglikon (1 ml of 0.06% solution) with 20 ml of 40% glucose solution; simultaneously can introduce 1-2 ml of 12% solution of aminophylline (diafillina) intramuscularly. Diuretics are used: novurite (0.5-1 ml) intramuscularly or intravenously, lasix 40-80 mg orally in the same dose intravenously together with 20 ml of 40% glucose solution, etc. When there is a threat of pulmonary edema, bloodletting of 250-500 ml of blood is indicated . To limit blood flow to the heart, a tourniquet is applied to the limbs for 15-20 minutes without squeezing the arteries, which is controlled by the presence of a pulse of the radial artery or artery of the rear foot. With a prolonged attack of cardiac asthma, not amenable to emergency therapy, the patient must be hospitalized. After an attack of cardiac asthma, the patient should observe bed rest for 2-3 weeks. At this time, a diet with a restriction of fluid and salt is needed . At the same time, the treatment of the disease against which the attack of cardiac asthma has developed is being carried out.