Cardiac Asthma
Introduction
Introduction to cardiogenic asthma Cardiac asthma is a paroxysmal asthma caused by left heart failure and acute pulmonary edema, and its clinical manifestations at the time of onset can be similar to those of bronchial asthma. Cardiac asthma has a history of hypertension or heart disease. In asthma, it is accompanied by frequent coughing, coughing, especially bloody sputum, heart enlargement, arrhythmia and heart sound abnormalities. Intrinsic refers to a group of comprehensive symptoms characterized by paroxysmal nocturnal dyspnea as a result of left heart failure due to various reasons. basic knowledge The proportion of the disease: the incidence rate of the elderly patients is about 0.2% - 0.3% Susceptible people: the elderly Mode of infection: non-infectious Complications: heart failure, acute pulmonary edema
Cause
Cause of cardiogenic asthma
Pathogenesis:
In the left heart failure, the left ventricular filling pressure, ie, the end-diastolic pressure is increased. As the left ventricular end-diastolic pressure increases, the left atrium and pulmonary venous pressure also increase, causing pulmonary capillary pressure to rise, leading to pulmonary congestion, pulmonary edema, and intrinsic The pathogenesis may be more than the lower extremity venous return to increase the amount of blood in the lower limbs, aggravating pulmonary congestion, at the same time, the surrounding edema fluid is reabsorbed in the supine position, so that the blood flow capacity is increased, and the heart load is more aggravated.
Left ventricular myocardial lesions and overload:
Left ventricular cardiomyopathy, such as coronary heart disease, acute myocardial infarction, hypertensive cardiomyopathy, hypertrophic cardiomyopathy, myocarditis, etc.; left ventricular pressure overload, such as hypertension, aortic stenosis, obstructive cardiomyopathy.
Left ventricular diastolic compliance decreased:
Mainly seen in coronary heart disease, hypertension, obstructive cardiomyopathy and diseases with left ventricular hypertrophy.
Severe arrhythmia:
Such as atrial fibrillation, atrial flutter, paroxysmal tachycardia, high atrioventricular block.
Extracardiac disease:
Such as pulmonary embolism, cerebrovascular accident, inhalation of irritating gas, excessive intravenous fluid, nephritis, renal failure and so on.
Prevention
Cardiogenic asthma prevention
1, should actively treat the primary disease and improve heart function.
2, it is not appropriate to keep cats, dogs and other small animals indoors.
3, usually should pay attention to the child's physical exercise, such as the usual cold water bath, dry towel body and other skin exercises, so that the nervous state of the lungs, trachea, bronchial vagus nerves are alleviated.
4, strengthen nutrition, avoid mental stimulation, avoid colds and excessive fatigue also play an important role in the prevention of asthma attacks.
Complication
Cardiogenic asthma complications Complications Heart failure acute pulmonary edema
1, heart failure
2, acute pulmonary edema
3, dying
Sudden death is the most serious complication, because it often has no obvious aura symptoms. Once it happens suddenly, it is often too late to rescue and die. Lower respiratory tract and lung infections. Water and electrolytes and acid-base imbalance due to asthma attacks, hypoxia, inadequate feeding, dehydration, heart, liver, especially respiratory and renal insufficiency, often complicated by water, electrolytes and acid-base imbalance, are important factors affecting asthma efficacy and prognosis Efforts should be made to maintain water, electrolytes and acid-base balance, and to monitor electrolytes and conduct arterial blood gas analysis every day, to detect abnormalities in time and to deal with them in time.
4, pneumothorax and mediastinal emphysema
As the gas is trapped in the alveoli during the asthma attack, the alveolar gas is excessive, and the intrapulmonary pressure is significantly increased. The emphysema that has been complicated by chronic asthma can cause the pulmonary bullae to rupture and form a spontaneous pneumothorax. When using mechanical ventilation, the airway and alveoli The peak pressure is too high, it is also easy to cause alveolar rupture and form a barotrauma, causing pneumothorax and even with mediastinal emphysema.
Symptom
Cardiac Asthma Symptoms Common Symptoms Paroxysmal nocturnal dyspnea asthmatic sputum pink pink-like wheezing sounds menstruation delayed heart enlargement urgency cardiovascular occlusion
The most prominent clinical manifestations were paroxysmal nocturnal dyspnea, cardiogenic asthma, typical episodes occurred mostly after sleeping for 1 to 2 hours at night, and the patient was suddenly awakened due to nausea and anger, and was forced to sit up and open the window immediately. Relieve the feeling of suffocation, accompanied by cough, asthmatic breath sounds or cough foamy phlegm, lighter sitting for more than ten minutes to 1h, breathing difficulties can automatically subside, patients can fall asleep, severely sustained attacks, frequent cough, Increased shortness of breath, cyanosis, sweating, cold hands and feet, cough up pink foamy sputum, and can develop into acute pulmonary edema, signs of the main disease in addition to the main disease, such as the heart and voice of the sound to the left to expand, apical lift pulsation In addition to S4 and valve murmurs, there are signs of left heart failure, such as increased heart rate, early diastolic galloping, wet lung sounds (especially the wet voice of the left lung base) and wheezing, pleural effusion (especially the right pleural effusion), blood pressure can be temporarily increased due to the contraction of small arteries caused by increased contractile sympathetic tone.
Examine
Cardiac asthma examination
In the case of concurrent infection, the total number of white blood cells may increase and the proportion of neutrophils may increase.
X-ray examination showed increased shadow of the two hilars, different degrees of pulmonary congestion such as lobular vein dilatation, interlobular edema, Kerley B line or pulmonary edema (cloudy cloud shadow), left ventricular enlargement, left atrium and pulmonary artery segmentation, etc. The electrocardiogram shows left ventricular hypertrophy, ST-T changes, echocardiography shows increased left ventricular diameter, and wall motion amplitude is weakened.
Diagnosis
Diagnosis and diagnosis of cardiogenic asthma
diagnosis
According to the cardiovascular disease and pulmonary congestion caused by left heart failure, left heart hypertrophy and/or enlargement, the clinical features of paroxysmal nocturnal dyspnea are not difficult to diagnose, but the intrinsic only occurs at night. Can be self-resolved, missed during the day without obvious symptoms or positive signs of no obvious heart failure.
Differential diagnosis
Can also be misdiagnosed as bronchitis or bronchial asthma due to difficulty breathing, cough, lungs, wet wheezing and wheezing, must be identified.
