Asthma cardiale is the term for the shortness of breath that one gets when the heart is no longer pumping strongly enough and therefore blood backs up into the lungs. It is thus the symptom of left heart failure.
What is asthma cardiale?
In principle, asthma cardiale, as it is called, is not a disease but a symptom of a disease. It is a medical term for shortness of breath, an irritating cough, and an audible “wheeze” when exhaling. Unlike bronchial asthma, which is much better known, however, the cause of cardiac asthma is found in the heart – the lungs are only the sufferer.
Causes
Heart failure can occur for several reasons: It usually affects older people whose hearts simply weaken with age. However, diseases such as metabolic or rheumatologic cardiomyopathies, acute events such as (repeated) heart attacks, or even myocarditis often contribute significantly to the development of heart failure and increasingly cause it to occur in younger people. Drugs can also weaken the heart muscle. Once this has occurred, the process cannot be reversed. The heart muscle is now no longer able to “pump away” its usual flow of blood, and the result is a buildup of blood in front of the heart. The backlog in front of the left ventricle can be traced back into the upstream pulmonary veins and into the pulmonary capillaries, where gas exchange with the air we breathe takes place. This increased volume in the small circulation already leads to the typical symptoms of asthma cardiale, but is not the end of the story. If the pressure in the vessel becomes too high due to the congested blood here, blood plasma and sometimes blood cells are “squeezed” into the lungs – fluid collects in the pulmonary alveoli, which then impedes gas exchange. If enough fluid is present, this can be heard by a respiratory synchronous “bubbling”, the typical moist rales of cardiac – i.e. heart-related – pulmonary edema. In a narrower sense, the term “asthma cardiale” also refers, by analogy with bronchial asthma, to constriction of the bronchial tubes, which obstructs the inflow and, above all, outflow of oxygen to the lungs. This also occurs through fluid leakage into the bronchial wall, causing it to swell. An audible “wheeze” on exhalation and an irritating cough are the result. If the blood eventually backs up even further and the right ventricle is also involved, there is also a back up into the greater circulation with leg edema and other symptoms.
Symptoms, complaints, and signs
Asthma cardiale is a serious disease, which thus leads to serious symptoms. In the worst case scenario, this disease can also lead to the death of the affected person if it is not treated properly or in time. The affected person suffers from asthma cardiale primarily by a strong cough. The cough occurs mainly at night, which can have a negative effect on the patient’s sleep. Many sufferers also suffer from sleep disturbances or depression and irritability. As the disease progresses, it also leads to shortness of breath and, in severe cases, loss of consciousness. If the internal organs are no longer supplied with oxygen, they can also be damaged. Pathological breathing noises occur, which are amplified especially at night. Many sufferers have the feeling that they would suffocate, so that a fear of death or a panic attack can also occur. Asthma cardiale is also often accompanied by frothy sputum. The overall physical resilience is also minimized by this disease. As a result, those affected also suffer from permanent fatigue and lassitude.
Diagnosis and course
Asthma cardiale, also analogous to bronchial asthma, often progresses in an attack-like fashion with shortness of breath. These attacks often occur at night between 2 and 4 am in the middle of sleep. At this time, edema is reabsorbed from the rest of the body and swept with the bloodstream into the pulmonary circulation. This causes acute overload of the latter, resulting in asthma cardiale with shortness of breath and coughing attacks. Most people, when they wake up in the middle of the night with such smyptoms, automatically get up and open the window to get fresh air.This also improves the air in most cases, which is due to the fact that the upright posture relieves the lungs and the blood volume is shifted more to the legs again in accordance with gravity. Since heart failure is a serious and severe disease, a doctor should definitely be consulted. He will then ask for a precise description of the symptoms and initiate a comprehensive diagnostic procedure, beginning with a physical examination. Even here, the eye, the hand and the stethoscope can reveal a great deal about the performance of the heart. An ECG, a cardiac ultrasound and an X-ray of the lungs are then part of the usual follow-up examinations, at least if acute shortness of breath and suspected pulmonary edema are present. In some circumstances, depending on the suspected cause of the asthma cardiale, cardiac catheterization may also be performed.
Complications
Various complications can occur with asthma cardiale. These involve a backlog of blood in the lungs (congested lung). If the backlog persists chronically, scar tissue may form in the lungs. As a result, the affected person can no longer breathe in completely and experiences shortness of breath, which is why he or she has to breathe faster and deeper. The backlog of blood can also cause fluid to leak into the lungs, which to a certain extent can lead to pulmonary edema. This can become inflamed and lead to pneumonia, which in the worst case can also lead to failure of the lungs (respiratory insufficiency). In this case, the patient suffers from oxygen deficiency, as he or she can no longer take in enough oxygen or release carbon dioxide. Cardiac asthma is caused by a weakness of the heart (heart failure). Heart failure is often accompanied by cardiac arrhythmias. In atrial fibrillation, for example, thrombi can form in the atrial wall due to stasis of the blood. These can break loose and be carried away with the bloodstream. This can lead to pulmonary embolism with shortness of breath and chest pain, or even to a stroke characterized by paralysis and loss of speech. In ventricular fibrillation, if left untreated, circulation can quickly stop and immediate cardiac death can also result.
When should you see a doctor?
If shortness of breath, shortness of breath or gasping for breath persists, a doctor should clarify the cause. The same applies if there is palpitations, dizziness or a general feeling of weakness without physical exertion or athletic overload. A visit to the doctor is particularly urgent if abnormal, usually rattling, breathing noises are noticed or foamy sputum appears. In case of choking sensations, an emergency physician must be called immediately, who can determine the asthma cardiale and, if necessary, treat it directly on the spot. Furthermore, immediate medical clarification is also required in the event of existing cardiac insufficiency or another disease of the cardiovascular system, the metabolism or the immune system. People who suffer from obesity, are smokers or consume excessive amounts of alcohol should discuss the above symptoms with their family doctor. If breathing difficulties or sputum occur as a result of over-exertion in sports or a flu-like infection, a medical examination is also necessary. Once diagnosed, the symptoms of asthma cardiale can be well treated. If the symptoms are chronic, regular medical evaluation may be required.
Treatment and therapy
Asthma cardiale as a symptom of heart failure can be treated quite well. Acutely, a strong diuretic such as furosemide is usually prescribed in the hospital, which expels water from the body within a short time. This relieves the pulmonary circulation and leads to resorption of the edema from the lungs – free breathing is the result. In the long term, heart failure is treated with a step-by-step therapy, which also starts with a diuretic or an ACE inhibitor; beta blockers or digitalis (cardiac glycosides) can also improve the function of the heart muscle. Regular medical checks of cardiac function and drug levels are necessary during the course.
Outlook and prognosis
The course of asthma cardiale is associated with fluctuations and depends on the severity of the disease. This ultimately leads to an unfavorable prognosis in a pronounced form of the disease.The symptoms change in the course of development and depend on the cardiac activity. In severe cases, the heart fails and the patient dies. The mortality rate is currently 5-10% of all patients. Normally, the older the patient, the lower the chances of recovery. Mild to moderate asthma cardiale, on the other hand, is easily treatable. With today’s medical possibilities, there is a good chance that this form of the disease will not lead to drastic changes or limitations in everyday life. Adjustments are necessary and overuse must be avoided. Nevertheless, participation in social and professional life is possible. In addition, the patient can take self-help measures, which are essential for an improvement of the symptoms. Avoiding stimulants such as alcohol and nicotine increases the chances of recovery. With regular check-ups and a healthy lifestyle, patients with cardiac asthma have a normal life expectancy. Nevertheless, complete freedom from symptoms or a cure cannot be expected at present. However, deterioration of health is possible at any time.
Prevention
If you don’t want it to get that far in the first place, you should of course live a generally healthy life, avoid risk factors for cardiovascular disease such as smoking or being overweight, and from the age of 35 take advantage of the health check-up at the family doctor, which is paid for by the health insurance companies. Here, elevated blood lipid levels or developing high blood pressure can be detected in time and treated accordingly. Furthermore, the symptoms described above should lead everyone quickly to the doctor. Adequate therapy of the early stages of heart failure can not only significantly improve the quality of life, but also reduce the otherwise massive mortality of this disease.
Follow-up
Follow-up care for asthma cardiale consists of medical checkups as well as lifestyle adjustments. Asthma cardiale is rarely truly curable, so aftercare measures are primarily designed to minimize the risk of the condition worsening. Risk factors include obesity, further weakening of the heart, and hypertension. These are the factors that need to be mitigated. This means that, if necessary, those affected must change their diet in order to return to a normal weight. In addition, moderately intense endurance sports should be done to improve the heart as well as breathing. It is essential to discuss the type and extent of sport with the doctor, so that overstraining does not occur. Alcohol and smoking have a very negative effect. In the presence of left heart failure, which is the most common cause of cardiac asthma, both should ideally be discontinued or reduced to a minimum. Since the symptoms appear mainly at night when lying down, in which gravity is also involved, sleeping in an elevated position is recommended. The upper body should always be positioned above the legs so that blood accumulations can sink more easily. This relieves the heart and lungs. Regular monitoring of the heart is important. Medications may also need to be adjusted.
Here’s what you can do yourself
Asthma cardiale is a symptom of left heart failure. Weakness of the heart muscle is best prevented. Particular risk factors are obesity, type 2 diabetes, smoking, and excessive alcohol consumption. But sports activities that lead to overexertion can also damage the heart muscle. Athletes should therefore adjust their training load to their physical condition and consult a doctor at the first sign of heart problems. Under no circumstances should heavy training be undertaken while suffering from a cold or flu. Uncured infectious diseases are one of the most common causes of heart failure in young people. Once cardiac asthma has developed, patients can independently mitigate only isolated associated symptoms. The severe cough combined with shortness of breath, which occurs mainly at night, is easier to bear for many patients if the upper body is slightly upright in bed. Here, the purchase of a special bed frame should be considered.To combat edema, which often forms not only in the lungs but also in the legs of those affected, naturopathy recommends draining remedies such as nettle tea or baths with Epsom salt, which is supposed to flush toxins and excessive fluid out of the body. It is also recommended to reduce the intake of common salt in the diet. Secondary plant compounds of hawthorn are used to strengthen the heart muscle.
