Cardiac arrhythmias in adult patients with asthma

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. 2012 Nov;49(9):942-6.

doi: 10.3109/02770903.2012.724132.

Epub 2012 Sep 27.

Miriam J Warnier 
¹
, Frans H Rutten, Jan A Kors, Jan Willem J Lammers, Anthonius de Boer, Arno W Hoes, Marie L de Bruin

Affiliations

Affiliation

• ¹ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.

• PMID:

  23013453

• DOI:

  10.3109/02770903.2012.724132

Miriam J Warnier et al.

J Asthma.

2012 Nov.

. 2012 Nov;49(9):942-6.

doi: 10.3109/02770903.2012.724132.

Epub 2012 Sep 27.

Authors

Miriam J Warnier 
¹
, Frans H Rutten, Jan A Kors, Jan Willem J Lammers, Anthonius de Boer, Arno W Hoes, Marie L de Bruin

Affiliation

• ¹ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.

• PMID:

  23013453

• DOI:

  10.3109/02770903.2012.724132

Abstract

Objective:

The pathogenesis of cardiac arrhythmias in asthma patients has not been fully elucidated. Adverse drug effects, particularly those of β2-mimetics, may play a role. The aim of this study was to determine whether asthma is associated with the risk of cardiac arrhythmias and electrocardiographic characteristics of arrhythmogenicity (ECG) and to explore the role of β2-mimetics.

Methods:

A cross-sectional study was conducted among 158 adult patients with a diagnosis of asthma and 6303 participants without asthma from the cohort of the Utrecht Health Project-an ongoing, longitudinal, primary care-based study. All patients underwent extensive examinations, including resting 12-lead electrocardiogram (ECG) and pulmonary function tests. The primary outcome was “any arrhythmia on the ECG” (including tachycardia, bradycardia, premature ventricular contraction (PVC), and atrial fibrillation or flutter). Secondary outcomes were tachycardia, bradycardia, PVC, atrial fibrillation or flutter, mean heart rate, mean corrected QT (QTc) interval length, and prolonged QTc interval.

Results:

Tachycardia and PVCs were more prevalent in patients with asthma (3% and 4%, respectively) than those without asthma (0.6%, p < .001; 2%, p = .03, respectively). The prevalence of QTc interval prolongation was similar in participants with (2%) and without asthma (3%, odds ratio [OR]: 0.6 and 95% confidence interval [95% CI]: 0.2-2.0). In 74 asthma patients, who received β2-mimetics, tachycardia and PVCs were more common (OR: 12.4 [95% CI: 4.7-32.8] and 3.7 [95% CI: 1.3-10.5], respectively).

Conclusions:

The adult patients with asthma more commonly show tachycardia and PVCs on the ECG than those without asthma. The patients with asthma received β2-mimetics; the risk of tachycardia and PVCs is even more pronounced.

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Cardiac Asthma: Causes, Symptoms, and Treatments

Despite the name, cardiac asthma isn’t a type of asthma. It refers to breathing difficulty caused by fluid buildup in the lungs as a result of heart failure.

Cardiac asthma can be potentially life threatening, and a proper diagnosis is critical. However, it can be misdiagnosed as asthma due to the similarities between the symptoms. People with either condition can experience coughing, shortness of breath, and wheezing.

Keep reading as we break down everything you need to know about cardiac asthma, including what causes it, what symptoms occur, and how it’s treated.

Cardiac asthma is a collection of asthma-like respiratory symptoms caused by congestive heart failure. The term “cardiac asthma” was first coined in medical literature in 1833 by Dr. James Hope.

People with cardiac asthma typically experience symptoms such as coughing, trouble breathing, and shortness of breath due to pulmonary congestion. This is a buildup of fluid in your lungs that impairs your ability to oxygenate your blood.

Your heart has four chambers: the left atrium, left ventricle, right atrium, and right ventricle.

In people with congestive heart failure, the heart can’t properly pump blood out of the left ventricle or the pressure in the ventricle is high. This disruption in blood flow leads to increased blood pressure in the blood vessels of the lungs, which causes leakage and accumulation of fluid.

Symptoms of cardiac asthma include:

• wheezing
• trouble breathing
• rapid breathing
• coughing
• grunting
• bloody sputum
• frothy sputum
• orthopnea (shortness of breath when lying down)
• rales (abnormal sounds heard when listening to the lung with a stethoscope)
• paroxysmal nocturnal dyspnea (waking up at night gasping for air)

Symptoms of cardiac asthma may be the initial symptoms of heart failure, or they may be present along with other signs of heart failure, such as:

• chest pain
• fainting
• fatigue
• irregular heart rate
• skin that appears blue
• swelling in the legs, feet, or ankles
• weight gain from fluid retention
• increased need to urinate, often at night

Cardiac asthma can be difficult to diagnose due to its similarity to asthma. Misdiagnosis is common. To differentiate between the two, a doctor will likely start by looking at your medical history and risk factors to determine whether heart failure is the cause.

Tests that may be performed to help diagnose heart failure include:

• Physical exam. The doctor may look for other signs of cardiac asthma and heart failure, such as abnormal sounds in your lungs when breathing and abnormal heart rate.
• Blood tests. The doctor may recommend a blood test to help diagnose conditions that can lead to heart failure, check for markers of increased fluid, and rule out other potential causes for your symptoms.
• Electrocardiogram. An electrocardiogram monitors the electric activity of your heart and helps identify abnormalities in your heart rhythm.
• Echocardiogram. An echocardiogram is a type of ultrasound that uses sound waves to produce a picture of your heart. The picture can show the doctor how much blood your heart is pumping and screen for irregularities or abnormalities in the pumping function.
• Chest X-ray. A chest X-ray can help identify an enlarged heart or fluid in your lungs.
• Breathing tests. Your doctor may recommend breathing tests like a spirometry test or a peak flow test to screen for lung problems.
• Other imaging techniques. A CT or MRI scan may also be used to produce images to assess the health of your heart.

Tips for your medical appointment

If you think you may be experiencing cardiac asthma, it’s critical to seek medical attention immediately.

Persistent wheezing, shortness of breath, and trouble breathing are all signs that you should talk with a medical professional, especially if your symptoms get worse when you lie down.

It can help to ask yourself the following questions while you’re waiting to see a doctor to help determine whether it’s cardiac asthma:

• Has anyone in my family experienced heart failure?
• Do I have any risk factors for heart failure, such as high blood pressure or coronary artery disease?
• Does anybody in my family have asthma?
• Have I had asthma before?
• Are there other potential causes for my breathing trouble, like the flu or a respiratory infection?
• Is my breathing trouble keeping me awake?

Was this helpful?

Classic asthma medications like bronchodilators are thought to have limited effectiveness for treating cardiac asthma. Treatment for cardiac asthma involves addressing the underlying heart failure and fluid buildup in the lungs.

Medications

Medications traditionally used to treat an emergency case of cardiac asthma include:

• morphine
• furosemide or diuretics to remove fluid
• nitroglycerin

Once your symptoms stabilize, you may be given ACE inhibitors or beta-blockers or both to prevent another episode. ACE inhibitors help widen blood vessels and unload the heart, while beta-blockers slow your heart rate and lower your blood pressure.

Oxygen and ventilation

If your body isn’t receiving enough oxygen, you’ll likely be given oxygen or put on a noninvasive ventilator. In severe cases, you could need a breathing tube. However, these treatments aren’t necessary if you’re able to breathe well enough to get adequate oxygen.

Surgery

Some people will need surgical interventions, such as an angioplasty or coronary bypass surgery, to improve blood flow to the heart and make the heart stronger. The final treatment option when all other treatments have failed is a heart transplant.

Lifestyle tips for cardiac asthma

Living an overall healthy lifestyle may help improve your heart failure symptoms or prevent heart failure in the first place. Some habits you can adopt include:

• exercising regularly
• avoiding smoking
• minimizing alcohol intake
• minimizing stress
• getting adequate sleep
• maintaining a healthy weight

Was this helpful?

Cardiac asthma is a secondary condition caused by heart failure. The outlook for people with heart failure improves the sooner they receive proper treatment. However, it can vary widely between people.

The life expectancy of somebody with cardiac asthma depends on how far their heart failure has progressed, the underlying cause, and their overall health.

Mortality rates at 1 year and 5 years after heart failure diagnosis are about 22 and 43 percent, respectively.

Cardiac asthma is a condition caused by heart failure that leads to asthma-like symptoms, such as wheezing, coughing, and trouble breathing. It’s caused by a buildup of fluid in the lungs due to the inability of the heart to effectively clear fluid from the lungs.

Cardiac asthma is often misdiagnosed as asthma, but a proper diagnosis is critical for receiving proper treatment maximizing your outlook.

Read this article in Spanish.

causes, symptoms, signs, diagnosis and treatment of pathology in the MEDSI Clinic

Cardiac asthma is a pathology that is provoked by stagnation of blood in the lungs. The disease is characterized by regular attacks of suffocation. They can occur not only during physical exertion, but also in stressful situations, with emotional stress and even slight excitement. Often, attacks occur in a state of complete rest, when the patient is sleeping. This is due to the fact that at night, during stress and vigorous activity, blood actively flows to the lungs. During an attack, the duration of which varies from 2-3 minutes to 1-3 hours, the patient has difficulty inhaling, feels the fear of death and often coughs.

Cardiac asthma is a disease, some symptoms of which at least once appeared in about 3% of the world’s inhabitants. Pathology with approximately the same frequency occurs in both sexes. As a rule, a complication occurs in people over the age of 55 years.

Important! Cardiac asthma is a complication, not a separate condition. It occurs with pneumonia, hypertension, heart defects and other serious diseases. Often, cardiac asthma is confused with bronchial asthma. For this reason, it is very important to consult a doctor and conduct a comprehensive diagnosis.

Since the pathology is dangerous and can cause sudden death, it is important to contact a specialist at the first of its manifestations. Do not wait for the recurrence of seizures!

Symptoms of cardiac asthma

The main signs of a pathological condition include:

• Prolonged exhalation and difficulty in inhaling the air causing severe discomfort and severe dyspnea
• Choking provoked by prolonged agonizing cough
• Pale skin
• Swollen neck veins
• Sweating
• Blueness (usually of fingers and lips)

If a critical condition occurs at night, the patient suddenly wakes up because he cannot breathe normally, and from this he instantly experiences a panic attack. Often, patients try to “breathe” at an open window. Such actions do not bring relief, since the pathology is in no way connected with a lack of oxygen in the room.

Causes of development

Pathology can manifest itself as a complication of diseases of the cardiovascular and other systems.

The main reasons for its development include:

• Heart failure
• Myocardial infarction
• Ischemic disease
• Aneurysms
• Heart defects

All these pathologies lead to the inability of the heart to contract normally (in the optimal mode). As a result, a sufficient outflow of blood is not provided, and it accumulates in the lungs, which provokes regular attacks.

Also, the causes of the disease include blood clots in the heart and tumors of the organ. Such formations become obstacles in the veins on the path of blood.

An attack can be triggered by:

• Hypertension, in which the pressure rises and the arteries overflow
• Strokes of various types and other brain injuries in which the control of lung function is impaired
• Infections (pneumonia, for example) leading to edema

Seizures are often caused by:

• Emotional stress
• General fatigue
• Large meals before bedtime
• Violation of fluid intake (especially in hypertensive patients)

These factors also stimulate blood flow to the lungs.

There are a number of other reasons for the development of complications. The doctor will tell you everything. He will also determine the cause of the pathological condition in your case. To do this, he will conduct a conversation and examination, as well as interview you. The consultation will allow you to determine the causes of the pathology and quickly find a way to eliminate it.

Diagnostics

It is quite difficult to recognize such a pathological condition as cardiac asthma. This is due to the fact that the complication has common features with a number of other diseases (up to fits of hysteria).

Diagnostics is always carried out comprehensively and includes:

• Inspection. The doctor diagnoses such signs of pathology as pallor and cyanosis of the skin, connection of additional muscles during inhalation, increased blood pressure
• Listening. At this stage of diagnosis, the doctor notices non-standard wheezing in areas where a stagnant process is noted, changes in heart tones, an increase in pulse rates (up to 150 beats per minute)
• ECG. This survey is one of the most revealing. It allows you to detect signs that indicate changes in the work of the heart
• Echocardiography. This examination is also called “ultrasound of the heart.” As part of the diagnostics, the specialist detects valve defects, changes in the thickness of the walls of the left part of the muscle and a decrease in its contractility
• Duplex scanning. This diagnosis allows you to determine the pressure in the heart, a decrease in blood volume and other factors indicating the presence of pathology
• X-ray examination. X-ray is done in 3 projections. Thanks to this, the doctor gets a complete picture of the work of the heart and lungs, detects congestive processes

Treatment

Treatment of complications should begin as early as possible, after the onset of the first attack.

The main first aid measures are aimed at:

• Improving the functionality of the heart
• Relieving nervous excitement
• Prevention of pulmonary edema

Further therapy is aimed at:

• Vascular spasm relief
• Lowering blood pressure
• Relief of discomfort (pain in the heart and shortness of breath)
• General relaxation
• Puffiness reduction
• Decreased heart rate

Cardiac asthma, the treatment of which should not be delayed, is often accompanied by a number of comorbidities. It is important to carry out their therapy. For this reason, treatment is always complex.

It includes:

• Taking medication to relieve major symptoms and reduce the risk of seizures
• Inhalations to prevent oxygen starvation of the body
• Taking drugs that help to remove excess fluid and relieve swelling
• Administration of drugs to relieve nervous excitability

Therapy is always selected taking into account the general condition of the patient, the presence of concomitant diseases and individual characteristics.

What to do in case of an attack?

Relatives of the patient should have some knowledge and skills to reduce the manifestations of an attack and alleviate the patient’s condition.

Remember 4 simple rules!

• At the first sign of an attack, call an ambulance
• Supply fresh air to the room where the sick person is. Be sure to take off your clothes. If you are outside, unzip the patient’s clothing
• Create conditions for the patient to take a comfortable position (in a chair or on a bed). Make sure your legs are down. This will stimulate the outflow of blood and improve the patient’s condition
• Remove foam and mucus from the mouth (if any)

If a critical condition has not occurred for the first time, and the patient already has specific recommendations from a cardiologist, they should be strictly followed. Doctors often advise to additionally dissolve a nitroglycerin tablet or take validol, for example.

Important! You should not refuse hospitalization, as an acute condition may recur in the near future or be delayed.

Benefits of treating cardiac asthma in MEDSI clinics

Cardiac asthma, which is treated in our clinics, is a dangerous pathology. We pay special attention to it and constantly use both traditional and innovative methods of therapy.

• Specialists are ready to provide quick assistance to the patient. You can call a team that will perform all the necessary (including resuscitation) actions
• We have a comfortable hospital for the complex treatment of cardiac asthma
• The work of MEDSI cardiologists is based on extensive experience in diagnostic and therapeutic practice using modern equipment from the USA, Japan, Germany and Russia
• We have facilities for both medical and surgical therapy (including minimally invasive interventions)

To undergo treatment, it is enough to make an appointment with a cardiologist by calling + 7 (495) 7-800-600.

Do not delay treatment, see a doctor now:

• Cardiologist appointment
• ECHO-KG Echocardiography (ultrasound of the heart)
• Treatment of coronary heart disease

description, symptoms, diagnosis and treatment. Scientific section of the clinic IAKI

Description

Bronchial asthma is a chronic non-infectious disease of the respiratory tract of an inflammatory nature. Chronic inflammatory processes in the respiratory organs lead to their hyperactivity, as a result of which, upon contact with allergens or irritants, bronchial obstruction instantly develops. Swelling, phlegm, and muscle spasm narrow the airway, making it harder to inhale and especially exhale.

An attack of bronchial asthma often develops after the precursors and is characterized by a short sharp inhalation and a noisy long exhalation. It is usually accompanied by a cough with viscous sputum and loud wheezing. Bronchial asthma can lead to the development of emphysema of the lungs and cor pulmonale, the occurrence of status asthmaticus.

Although there is no cure for asthma, proper management can bring the disease under control and allow people to live quality lives.

Symptoms

• shortness of breath;
• wheezing;
• wheezing when breathing;
• chest tightness;
• cough;

People with asthma may experience symptoms several times a day or a week, and in some people the condition may worsen during physical activity or at night.

At the time of the onset of symptoms, a person has a feeling that he is breathing through a straw. When air passes through narrowed airways, wheezing can occur. Coughing is more common at night or in the early morning. Chest pain, a feeling of pressure or tightness in the chest can also be symptoms of asthma.

An asthma attack is characterized by very severe symptoms. During an attack, the patient may breathe so rapidly that he can hardly speak. Coughing, wheezing, and tightness in the chest can cause anxiety and fear. This, in turn, can lead to increased shortness of breath. In rare cases, blue or grayish discoloration of the fingertips can be seen with low levels of oxygen in the blood. In the event of an attack, you must immediately call an ambulance.

Asthma can be a congenital disease inherited from parents, or an independent disease. In bronchial asthma, the airways are more sensitive than usual. They can be easily irritated and spasmodic as a result of many factors, which are called “triggers”.

For example, there are the following triggers:

• Allergies: tree pollen, grass pollen, molds, cat and dog dander, house dust mites – if the lungs are severely irritated, allergens can provoke an asthma attack.
• SARS: Frequent viral infections can exacerbate asthma.