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Saturday, April 26, 2008

Cardiac asthma should not be treated as asthma

I have spent so much time writing about and educating nurses and students about cardiac asthma that I have decided it needs a post of its own.

And, considering about half of all breathing treatments I do are either for pneumonia or cardiac asthma, I am hereby convinced that even doctors have no clue what the difference between true asthma and cardiac asthma is.

According to the, here is the definition of Cardiac Asthma:
The term "cardiac asthma" refers to wheezing associated with congestive heart failure. It isn't true asthma. As a result of congestive heart failure, fluid can build up in the lungs (pulmonary dema). This causes signs and symptoms — such as shortness of breath, coughing and wheezing — that may mimic asthma. True asthma is a chronic condition caused by inflammation of the airways, which can lead to breathing difficulties. The distinction is important because treatments for asthma and heart failure are very different
Cardiac asthma is mainly caused due to increased pressure in the pulmonary vessels causing fluid to fill the air sacs, "preventing them from absorbing oxygen," and making the person feel extremely short-of-breath.  This same increased pulmonary vessel pressure (increased pulmonary vascular resistance) in turn squeezes the bronchioles and causes the wheeze and other symptoms that mimic real asthma, and this is why this "problem" is quite often mistaken for asthma and treated with bronchodilators. Secretions sitting on the vocal cord may enhance the wheeze, often causing it to be audible. (Keep in mind that a true bronchospasm wheeze cannot be heard sans stethoscope).

When Cardiac Asthma is treated as bronchospasm, all we are doing is putting adding more fluid to lungs that are already filled with fluid. What we need to do is give these patients diuretics to get rid of some of the fluid, or other cardiac drugs to increase the force and contractility of the heart to reduce pulmonary pressure.

Another good strategy worth trialing is CPAP or BiPAP, as the incrased airway pressure has been shown to reduce preload and afterload to reduce the work the heart has to do to pump blood through the body. This can reduce the feeling of air hunger until the medicines take effect.

Other than the heart, there are other diseases that can cause pulmonary edema and cardiac asthma, and these include pneumonia, exposure to toxins, and high altitudes. It is the job of the nurse, the respiratory therapist, and doctor to determine the true cause of the symptoms. It is the doctors job to properly diagnose and treat.

We'll consider this RT Cave rule #26: Cardiac Asthma should not be treated as asthma. Throat wheezes, upper airway wheezes, and dyspnea on exertion are signs of cardiac asthma, and a wise medical specialist will not confuse the two.


Anonymous said...

Thanks for the comments. I like that phrase " The mellow asthmatic" lol. May I use it for a future post?

YEAH, Im pretty much steroid dependent with a maintenance dose of 20mg pred , advair and additional flovent for difficult tapers.

Going from 30 to 20mg is the hardest part of the taper for me.

Ive been on 20 mg daily for the past years, luckily with only minor side effects. When I was younger I was a maintenance dose of 40-60 and sometimes as high as 100 mg per day.I had really severe Cushings syndrome and a ton of other stuff. It took a full year on Methotrexate and high dose inhaled steroids to come off.

So, I take it you're an asthmatic?
Tell me more about the psych thing.
Use my regular email if you want.


Mad Asthmatic said...

I've just been discharged from hospital after a rather traumatic time where I suffered a cardiac and resp arrest due to fluid building up in my lungs and heart and pneumonia. I have been an asthmatic for a long time but have now been told I have got cardiac asthma as well as bronchial asthma. I stumbled across your blog and was really interested in your post. I am walking a bit of a tightrope as withdrawl of my asthma medications causes my lungs to get very wheezy and these wheezes have been shown to be due to the bronchial and not the cardiac asthma. I am now worried about having future attacks because the treatment for each type is so different. Thank you for such an interesting post, it has given me a lot of information.

Mad Asthmatic

Anonymous said...

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Anonymous said...

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oldmanskates said...

This is almost a daily battle on the hospital floor. As an RRT being well informed on this topic brings around better patient care and dissolves friction between the RRT and nursing. The cardiac wheeze is heard loudest with stethoscope on the lower 'neck' and will often transmit fainter wheezes heard throughout the chest. I find most nurses are receptive to the correct treatment when you take the time to share your knowledge. Cheers!

Rick Frea said...

Thanks oldmanskates. I'm glad you brought this to my attention again. I think I'll make this an RT Cave rule.

modiskar said...

Would there be presence of pedal edema when cardiac asthma surfaces

modiskar said...

Would there be presence of pedal edema when cardiac asthma surfaces

Anonymous said...

I am an ER nurse with severe hard to controll asthma. I have an increasing frustration as noone has any good reasons. I have been told everything from VCD, though multiple normal scopes during attack, anxiety, to I just don't come in soon enough. After multiple intubations, reap arrest leading to collapsed lung, and now pacemaker for pauses, your article intrigues me. When I discussed it with MD, he acted like I was an idiot. Are they resistant to diagnose?

theuniqueldy said...

I just left my new PC and because he said he thinks I have cardiac asthma (and not regular asthma) & do not need the singular I looked up cardiac asthma and found this post. I had CHF several years ago soon after (@ 55) I had my 1st asthma attack (I was hospitalized for 15 days). Thank you so very much for this info