Cardiac Asthma

Could That Wheezing Be My Heart?

Cardiac Asthma
Is My Wheezing A broken Heart. Getty Images

I am sometimes told by patients that they have cardiac asthma and they are wondering if they need asthma-specific treatment. These patients often wonder if the following symptoms are due to asthma:

Cardiac Asthma Is Different From Asthma

Despite many patients thinking differently and experiencing asthma-like symptoms, cardiac asthma is not really asthma.

While the pathophysiology of asthma involves inflammation and narrowing of airways, symptoms in cardiac asthma are due to the underlying condition.

Heart failure, a condition where the heart does not pump normally, can sometimes mimic asthma and is sometimes referred to as cardiac asthma by patients. Wheezing in cardiac asthma is not due to narrowing of the airways and inflammation, but due to fluid in the lungs. When the heart pump is not working correctly, fluid tends to back up into the lungs. The fluid in the lungs is what leads to wheezing in the lungs.

Heart failure is not really a specific condition, but a conglomeration of symptoms. In other words, heart failure has a cause and your doctor must determine the cause in order to provide you the best treatment. Sometimes heart failure results from narrowing of the arteries that provide blood supply to the heart. Other times high blood pressure over many years leads to damage of the heart and the poor pump function.

Over times these conditions lead to the heart becoming weak, stiff, or both.

Sometimes the poor heart function is not due to poor blood flow, often called cardiomyopathy. Viral infections, drug abuse, and alcohol abuse can all lead to damaged heart muscle and the symptoms of congestive heart failure.

Finally, some medical problems can overwork the heart and result in damaged heart muscle. These include heart valve problems, thyroid disease, chronic kidney disease, or diabetes.

Sometimes treatments can reverse the underlying disease and the symptoms experienced improve.

What Are The Symptoms Of Cardiac Asthma

In addition to asthma like symptoms of wheezing, shortness of breath, and coughing, cardiac asthma may lead to dependent fluid retention in the ankles and lower extremity referred to as edema. Addition patients may notice an increase in weight as a result of the fluid retention. Patients with heart failure report other symptoms that can be similar to patients with poorly controlled asthma including fatigue, weakness, and being more tired.

Is Cardiac Asthma An Emergency?

It can be. When the symptoms are severe enough it can lead to hypoxemia or too little oxygen in the blood. Cardiac asthma can ultimately require ventilatory support such as intubation or admission into an intensive care unit.

If the cardiac asthma patient is experiencing an acute decrease in blood flow to the heart in an acute myocardial infarction or heart attack, the episode can be life threatening.

Interestingly, nearly a third of all elderly patients with congestive heart failure will present with wheezing.

How Is Cardiac Asthma Diagnosed?

In most cases the diagnosis is clinical with your doctor If your doctor suspects that your symptoms are not due to asthma, they may order a number of tests to look for congestive heart failure such as:

  • BNP— blood test that is elevated in congestive heart failure.
  • Echocardiogram— ultrasound test of the heart that looks to see how well your heart is pumping.
  • ECG- a heart tracing that can quickly identify acute problems with the heart and identify if you have had prior damage to the heart.
  • Cardiac MRI- many centers have begun doing MRI exams to look for calcium deposits and blockages in the blood vessels that supply the heart.

How Is Cardiac Asthma Treated?

The main treatment will be to address the underlying cardiac disease. If the symptoms are being caused by a poor heart pump then treatments will focus on that with medicines such as:

  • Diuretics- cause increased urination and removal of fluid
  • ACE Inhibitors- decrease pressure on the heart
  • Nitrates- Cause vasodilation and decrease volume overload

In the short term, your doctor will likely treat with short-acting beta agonists (SABA) in order to improve symptoms. Additionally, If you have hypoxia then you will be treated with oxygen. Cardiac asthma patients with symptoms of shortness of breath generally respond quickly to SABAs.

In some cases, you may be treated more like an asthma patient with systemic steroids. This will usually be when you do not respond quickly to diuretics and there is some potential concern that you have asthma or some component of reactive airway disease or COPD. If there is a concern you may also receive antibiotics.

If your doctor suspects that your wheezing is due to cardiac asthma, you may not have asthma at all. That is why it is important to see your doctor about any symptoms that appear to be asthma. One important tenet they teach in medical school is that not all that wheezes is asthma. Only an appropriately trained physician can identify what your symptoms are from and then provide you the most appropriate treatment.

Sources

  1. Jorge S, Becquemin MH, Delerme S, Bennaceur M, Isnard R, Achkar R. Cardiac asthma in elderly patients: incidence, clinical presentation, and outcome. BMC Cardiovasc Disord 2007. 7: 16.
  2. National Heart, Lung, and Blood Institute. What is heart failure?
  3. Keet CA, McCormack M. Cardiac Asthma: An Old Term That May Have New Meaning? J Allergy Clin Immunol Pract. 2016 Sep-Oct;4(5):924-5.
  4. Bang CL, Porsbjerg CM. Think twice - Diagnostic delay in a patient with acute chest pain. Respir Med Case Rep. 2016 Aug 20;19:94-7.

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