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How Is Cardiac Asthma Diagnosed

Cardiac Asthma: Causes Symptoms And Treatment

Refractory Asthma Diagnosis

Cardiac asthma isnt a type of asthma, it refers to breathing difficulty caused due to fluid build-up in the lungs because of heart failure. It is a potentially fatal disorder and proper diagnosis, and treatment is critical. But it can be misdiagnosed as asthma due to the similarities between the symptoms, where people suffering from either condition can experience coughing, shortness of breath and wheezing.

Differences Between Bronchial And Cardiac Asthma

A few examinations are necessary to reliably differentiate cardiac asthma from bronchial asthma. Basically, however, it can be said that bronchial asthma is a disease that usually occurs in early childhood and remains in varying degrees into old age. Cardiac asthma, on the other hand, is a disease that only occurs in the course of a serious underlying disease of the heart and thus more of a disease of old age.

However, an examination of the lungs and heart is required for a reliable differentiation. The lungs are examined with the help of a lung function test and also subjected to a provocation test, which is supposed to trigger a mild asthma attack. If this test is negative, bronchial asthma is almost always excluded.

The heart, on the other hand, can be examined with a series of examinations for cardiac insufficiency that leads to cardiac asthma. The means of choice here are the EKG and the ultrasound examination of the heart and the heart valves. If there are changes here, cardiac insufficiency can be reliably proven.

Alternatives To Diagnose Chronic Obstructive Pulmonary Disease In Heart Failure

Body plethysmography results can improve the diagnostic accuracy of detecting COPD. Determining the ratio of residual volume and total lung capacity is worthwhile, because COPD is very often accompanied by air-trapping and hyperinflation. Hyperinflation is a valid indicator of true COPD, especially in patients with decompensated HF. Hence, before considering long-term bronchodilator therapy in patients with HF and suspected COPD, comprehensive pulmonary function testing should be considered.

In conclusion: hyperinflation is a valid indicator of true COPD in patients with HF, even when performed when patients were recently decompensated.

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Clinical Diagnosis Of Asthma

Diagnosis of bronchial asthma is facilitated by using the following diagnostic criteria:

  • attacks of suffocation with difficulty exhaling, accompanied by dry rales over the entire surface of the lungs, which can be heard even from a distance
  • equivalents of a typical attack of bronchial asthma: paroxysmal cough at night, disturbing sleep resurgent wheezing difficulty breathing or feeling tight in the chest the appearance of cough, wheezing, or wheezing at a certain time of the year, in contact with certain agents or after physical exertion
  • the detection of an obstructive type of respiratory failure in the study of parameters of the function of external respiration (decrease in FEV1 of the Tiffno index, peak expiratory flow rate, maximum volumetric expiratory flow rate at the level of 50-75% FVC-MOS50, MOS75 in the analysis of the “flow-volume” loop
  • daily variability of peak expiratory flow rate
  • disappearance or significant relief of breathing and an increase in FEV1 by 20% or more after the application of bronchodilators
  • the presence of a biological marker of bronchial asthma – a high level of nitrogen oxide in the exhaled air.

Diagnosis of clinical and pathogenetic variants of bronchial asthma according to GB Fedoseev is presented below.

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Confirmation Of Congestive Heart Failure And Copd

Cardiac Asthma  Causes, Symptoms, Diagnosis &  Treatment ...

The complete medical chart was reviewed, especially noting medications including loop diuretics, nitrate, bronchodilatators and other treatments. Response to diuretic or vasodilator, results of echocardiography-Doppler, or BNP and NT-proBNP levels when available were specifically analyzed for the confirmation of CHF, by experts . Thereafter, patients with CHF as defined by experts were separated in two groups: patients with wheezing reported by the attending physician in the emergency room at admission were included in the cardiac asthma group and patients without wheezing were included in the classical CPE group.

The diagnosis of COPD was made by experts according to reports from a general practioner, respirologist or medical chart from previous admission patients’ current symptoms , clinical findings and radiographic findings of thoracic distension . On the chest X-ray, thoracic distension was defined by the presence of one of the following radiological signs: enlargement of intercostal space, horizontalization of the ribs, or flat diaphragm. Patients with history of chronic bronchitis and signs of emphysema but without PFT were also included in the COPD group .

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Whats The Outlook For People With Cardiac Asthma

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

Cardiac Asthma Should Not Be Treated As 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 . 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

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Prevalence Of Chronic Obstructive Pulmonary Disease In Patients With Heart Failure

Published estimates on the prevalence of COPD in patients with HFrEF varied considerably among studies, ranging from 8% to 52%. Differences in these rates may be due to numerous factors such as geographical region, age and sex distribution, urban environment, and smoking prevalence of the study population, but importantly also depend on the diagnostic criteria and definition of COPD applied, and whether patients underwent spirometry while in a euvolaemic and stable condition of HF. Surprisingly, only a few studies included spirometry to determine the presence of COPD ., , , – Most studies relied rather on medical recordings or patients self-report to diagnose COPD. Reliable estimates of the prevalence of COPD in a representative sample of HF patients in a stable situation with preserved ejection fraction are still lacking.

In conclusion: overdiagnosis of COPD in HF is very likely when spirometry is performed when HF patients are unstable. Based on studies performed in stable HF, the prevalence of COPD defined according to a post-dilatory value of FEV1/FVC < 70% varies between 9% and 44% , depending on population characteristics, the timing of pulmonary function testing, and the method or definition applied to diagnose COPD.

Causes: How Does Cardiale Asthma Come About


The cause of cardiac asthma is left heart failure with backward failure and pulmonary congestion.

This means that the pumping weakness of the left heart causes the blood to back up in the lungs in front of it, which increases the pressure in the vessels of the pulmonary circulation. There is an escape of fluid and blood components from the pulmonary vessels into the alveoli. Secondarily, the bronchi may narrow and the symptoms of asthma cardiale.

A further increase in pressure in the pulmonary circulation leads to the formation of further transudates, which are coughed up as a foamy, reddish-colored liquid acute pulmonary edema occurs.

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Diagnostic Criteria For Glucocorticoid Insufficiency

  • Clinical observation and detection of glucocorticoid insufficiency: no effect with long-term treatment with glucocorticoids, corticostependence, the appearance of skin pigmentation, the tendency to arterial hypotension, deterioration of the state with the abolition of prednisolone or a decrease in dose.
  • Reduction in the blood cortisol, 11-ACS, a decrease in urinary excretion of 17-ACS, an inadequate increase in urinary excretion of 17-ACS after administration of adrenocorticotropic hormone, a decrease in the number of glucocorticoid receptors on lymphocytes.
  • Bronchodilators In Heart Failure: Beneficial Or Detrimental

    Beta-2-agonists may increase heart rate, worsen cardiac function, and might decrease potassium levels, thus facilitating hypokalaemia-induced arrhythmias and tachycardias, as well as sudden cardiac death.-

    Theoretically, however, short-term use of beta-2-agonists may also exert positive effects in acutely decompensated HF, and in subjects presenting with wheezing, since they may reduce pulmonary congestion by increasing transepithelial sodium and chloride transport, as shown in animal models., , In addition, small sized studies showed that short-term use of beta-2-agonists increases FEV1, improves peripheral oxygen delivery, increases cardiac index, and decreases systemic vascular resistance, even in stable patients with HFrEF. So in acutely decompensated HF, short-acting bronchodilators may result in immediate symptom relief, and bridge the time gap until i.v. diuretics and nitrates start working. On the other hand, the described adverse effects of beta-2 agonists may limit even the short-term use in both acutely decompensated and stable HF.

    In any case, after initiation of bronchodilators, physicians should carefully monitor symptom improvements and side effects in patients with HF, and eventually consider drug discontinuation.

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    Violations Of The Nervous Regulation Of Respiration

    In patients suffering from neuroses, hysteria, especially in women, often have attacks of dyspnea, which makes it differentiate with bronchial asthma. As a rule, patients suffering from neurogenic breathing disorders, associate a feeling of lack of air and shortness of breath with an acute psychoemotional stressful situation, often are very neurotic. The main diagnostic sign that distinguishes neurotic or hysterical asthma from bronchial asthma is the absence of wheezing in auscultation of the lungs.

    Asthma Pathophysiology And Its Phenotypes

    Cardiac Asthma  Causes, Symptoms, Diagnosis &  Treatment ...

    Asthma is a chronic airway disease of varying pathophysiology, which includes eosinophilic, neutrophilic, mixed granulocytic, and paucigranulocytic pathways. The classic pathway of asthma involves the release of thymic stromal lymphopoietin by epithelial cells when an allergen or infectious agent enters the airway. This then activates Th2 cells, which produce various cytokines, including IL-4, IL-5, and IL-13. These cytokines then lead to the IgE formation and eosinophil activation responsible for airway hyper-responsiveness .25 Activation of mast cells via the attachment of IgE to high-affinity IgE receptors leads to the release of histamine, cysteinyl leukotrienes, and prostaglandins, which are also involved in bronchoconstriction.32

    Figure 2: Th2 pathogenesis of asthma.ILC2: Type 2 innate lymphoid cells TSLP: thymic stromal lymphopoietin.

    As we better understand different asthma phenotypes and the biomarkers that identify them, we can target medical therapy more precisely and develop new agents that target specific pathological pathways of asthma.

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    How Are These Conditions Ruled Out And Asthma Correctly Diagnosed

    To make an asthma diagnosis and make sure your symptoms are not caused by another condition, your doctor will review your medical history, family history, and symptoms. They will be interested in any history of breathing problems you might have had, as well as a family history of asthma or other lung conditions, allergies, or a skin disease called eczema, which is related to allergies. It is important that you describe your symptoms in detail , including when and how often they occur.

    You will be asked if you smoke now or have ever smoked. Smoking with asthma is a serious problem. Smoking is also a major factor in certain asthma mimics, including COPD and cancer. You will also be asked about past exposure to harmful chemicals, possibly at a job.

    Your doctor will also perform a physical examination and listen to your heart and lungs.

    There are many tests your doctor might perform, including lung function tests, allergy tests, blood tests, and chest and sinus X-rays. All of these tests can help your doctor determine if you have asthma and if there are other conditions affecting it.

    For more information, see WebMD’s article on Asthma Tests.

    Assessment Of The Body

    People with both conditions may appear to be working hard to breathe. Those experiencing heart failure may have a hard time breathing while lying flat. Their feet and ankles may be swollen. Their stomachs may appear bloated. Asthma usually does not present with a bloated stomach or feet or ankle swelling.7-8

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    Cardiac Asthma: The Alternative Diagnosis

    The term asthma cardiale was first mentioned in the literature > 180years ago and was thought to distinguish bronchial asthma from the clinical picture seen in acutely decompensated HF. The main trigger of expiratory obstruction with the clinical sign of wheezing in asthma is an allergen, while in acutely decompensated HF abrupt pulmonary congestion with increased interstitial fluid pressure causes external, mechanical obstruction and reactive spasms of the bronchi. Wheezing is technically produced by narrowing or obstruction of the bronchi. A study that defined cardiac asthma as the presence of wheezing at initial presentation found a prevalence of 35% in patients with acute HF. Interestingly, this prevalence is comparable with the overestimated prevalence of COPD found in most of the studies conducted in HF based on spirometry when patients were unstable .

    In conclusion: cardiac asthma is a clinical picture based on externally induced pulmonary obstruction of cardiac origin, and wheezing may be present in one-third of patients with acutely decompensated HF.

    How Is Cardiac Asthma Treated

    Cardiac asthma (Medical Symptom)

    It is essential that Cardiac Asthma be treated at the right time to prevent any complications but before than that it is extremely vital to diagnose the condition as the symptoms presented by Cardiac Asthma are quite similar to other unrelated medical conditions like True Asthma, COPD, or pneumonia. Once the condition is identified then treatment is first aimed at improving the function of the heart so that the heart is able to pump blood normally.

    Surgery may be recommended in some cases to treat certain heart conditions to include a gap between the chambers of the heart.

    The next step towards treatment is control of edema. Heart failure is treated with medications including diuretics so that any excess fluid in the lungs or the ankles can be eliminated from the body. Medications are also given to improve the functioning of the heart and the ability of the heart to pump blood effectively and normally to all the parts of the body. Once heart failure is controlled adequately then the other symptoms of Cardiac Asthma to include wheezing cough also gets improved. The treatment for Cardiac Asthma includes a combined approach using bronchodilators, supplementary oxygen, and also the treatment of the heart failure. Steroids are given to people who do not successfully respond to the initial treatment given for Cardiac Asthma.

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    What Is A Chest X

    By viewing your lungs on an X-ray, your doctor can see if you have another health condition that may be causing asthma-like symptoms. Asthma may cause a small increase in the size of your lungs , but a person with asthma will usually have a normal chest X-ray. Patients with COPD will also have hyperinflation, but emphysema causes holes in lung tissue, called blebs or bullae, which are evident on a chest X-ray. A chest X-ray can also make sure you don’t have pneumonia or lung cancer, particularly in smokers.

    Severity Grading Of Chronic Obstructive Pulmonary Disease In The Presence Of Heart Failure

    Until recently, severity of COPD was graded on the reduction of FEV1. This approach results in overestimation of COPD severity in patients with HFrEF, because HF itself causes a 20% reduction in FEV1 . Because FEV1 poorly correlates with symptoms and the risk of exacerbations in COPD, the international guidelines on COPD introduced a new severity classification system, incorporating symptom load and history of exacerbations in combination with FEV1 reduction. Patients with COPD can thus be classified into four groups and treated according to severity grade as specified in Figure. Breathlessness may be assessed with the Modified British Medical Research Council questionnaire or the COPD Assessment Test .


    ADet al.

    These questionnaires cannot discriminate between cardiac- and pulmonary-induced breathlessness and physical limitations. Moreover, exacerbations of COPD might be confused with or triggered by episodes of cardiac decompensation. Thus, the new severity classification system for COPD can also be expected to mediate over-rating the severity of COPD and consequently overtreatment with inhaled pulmonary drugs when patients have not only COPD, but also HF.

    In conclusion: because HF itself reduces FEV1 and causes dyspnoea and functional limitations, overestimation of the severity of COPD is likely in those with concomitant HF and COPD.

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    Diseases That Cause Obturation And Compression Of The Bronchi And Trachea

    Significant difficulties in breathing, especially exhalation, can occur when the trachea and large bronchi are compressed by benign and malignant tumors, sharply enlarged lymph nodes, and aortic aneurysm. Tumors can cause obturation of the bronchus with growth in the lumen of the bronchus.

    In the differential diagnosis of bronchial asthma, it should be noted that in the above situations, auscultatory symptoms are observed in one side, and not over the entire surface of the lungs, as in bronchial asthma. It is also necessary to analyze the clinical symptoms characteristic of diseases that cause occlusion or compression of the trachea and bronchi . The mediastinal tumor is characterized by the syndrome of the superior vena cava . To clarify the diagnosis bronchoscopy, x-ray tomography of the mediastinum, computed tomography of the lungs are performed.

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    Cardiac Asthma: Causes Symptoms And Treatments

    Pseudo asthma

    Cardiac asthma is not a form of asthma. Its a type of coughing or wheezing that occurs with left heart failure. Depending upon how extreme your signs and symptoms are, this hissing can be a medical emergency situation. Heart failure can create liquid to accumulate in your lungs and in and around your airways. This can create shortness of breath, coughing and wheezing comparable to the signs and symptoms of asthma.

    Real asthma is a chronic problem brought on by inflammation of the airways, which can tighten them, causing breathing problems. Real asthma has nothing to do with fluid in the lungs or heart disease.

    The difference is necessary because treatments for asthma and heart failure are various. Treatments for heart failure can aid boost your signs of both heart failure and cardiac asthma. Overusing treatments for true asthma, such as rescue inhalers, could be dangerous and potentially result in a worsening of signs.

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