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.

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.

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.

    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.


    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? Accessed October 13, 2014.

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