Cardiac Asthma – Symptoms and Treatment

Cardiac asthma is a medical condition in which the patient presents with the presentation of asthma, however the symptoms are not caused by pulmonary issue, rather it’s due to cardiac issue (congestive cardiac failure).

One study found that almost one third of the elderly patients suffering with congestive heart failure presented with cardiac asthma.

Cardiac asthma is a medical emergency as the patient might be suffering from acute heart failure. The acute cardiac failure may result in pulmonary edema (fluid build up in the lungs), resulting in overall presentation of the patient.

Please note that each patient is an individual case, therefore don’t start treating them blindly and consult a specialist whenever there is any health issue, specially related to cardiopulmonary system, including cardiac asthma.

While managing a patient with symptoms of cardiac asthma, it’s important to make a distinction between cardiac asthma and true asthma, while keeping in mind that both conditions may be present in your patient too. Also keep in mind that certain medications used for regular asthma (true asthma) can in fact worsen cardiac asthma and result in cardiac arrhythmia.

What is Cardiac Asthma?

Unlike the name may signify, cardiac asthma is not a type of asthma. It’s a condition related to heart failure in which there are symptoms including coughing and wheezing, mimicking asthma. It’s an emergency condition and should be diagnosed and managed properly.

Heart failure is the commonest underlying reason for cardiac asthma. The fluid accumulation in this condition results from the inability of heart to pump blood effectively which in turn leads to the narrowing of air passages. The increased work load on left ventricle of heart is also responsible for the cardiac asthma.

Is cardiac asthma an old age disease only?

Cardiac asthma is often linked to old age patients, however it can occur at any other age too, specially to those people who are suffering from any heart issues already or have any other issue leading to the tendency for accumulation of unhealthy fluid, such as patients with valvular heart disease, defects in internal walls and septum of heart, etc.


What is pulmonary edema?

When the heart fails, the fluid starts accumulating in the lungs, called pulmonary edema. There is fluid accumulation around and inside the airways in cardiac asthma too.

The symptoms of pulmonary edema in cardiac asthma include:

  • Shortness of breath
  • Coughing
  • Wheezing

These symptoms may mimic asthma.

What is asthma?

Asthma is a chronic disease in which there is inflammation of the airways. This results in the narrowing of the air passages, leading to difficulty in breathing. True asthma isn’t linked with fluid accumulation in lungs (pulmonary edema) or heart disease.

External factors in cardiac asthma

Cardiac asthma is mostly caused by internal factors, however external factors also play an important role in triggering it too including:

  • Weather
  • Smoke
  • Pollution

Difference in Treatment for cardiac asthma and true asthma

Since both are a different disease condition, the management for the patients vary too. In fact if cardiac asthma patient is treated on the line of true asthma, it may sometimes worsen the condition of the patient.

Signs and symptoms of Cardiac Asthma

Signs and symptoms of cardiac asthma vary in different patients in intensity. They usually appear during sleep or after exercise.

Main symptoms of cardiac asthma include shortness of breath, chest pain, rapid shallow breathing, increased heart rate, high blood pressure, swelling at ankles, etc. These symptoms may worsen with time and patient may also suffer orthopnea or nocturnal dyspnea (waking up in the middle of sleep due to shortness of breath). Swelling around ankles (pedal edema and tibial edema) is a characteristic of cardiac asthma if seen with a patient presenting with other symptoms mimicking asthma.

Cardiac asthma and pulmonary edema, both are an important symptoms of heart failure. It’s a life threatening emergency condition and medical care should be provided as soon as possible to the patient.

Main symptoms of cardiac asthma include:

  • Shortness of breath
  • Wheezing (may or may not be present)
  • Increased rapid and superficial breathing
  • Hypertension (increased blood pressure)
  • Tachycardia (increase pulse / heart rate)
  • Feeling of uneasiness
  • Paroxysmal nocturnal dyspnea (waking up in the middle of sleep due to breathlessness and sit up right to breath properly).
  • Edema around feet, ankles or tibia

Causes of Cardiac Asthma

Cardiac asthma is usually an indicator of heart failure due to some major mechanical reason. It can be a life threatening condition and should be diagnosed and managed on time. The pumping capability of the heart is reduced and results in fluid buildup in lungs, resulting in narrowing of air passages, presenting as wheezing and other symptoms related to asthma.

Various causes of cardiac asthma include:

  • Valvular heart disease
  • Cardiac muscle dysfunction
  • Increased pulmonary venous pressure
  • Renal artery stenosis

Cardiac Asthma Treatment

The key to effective treatment of cardiac asthma is prompt and correct diagnosis. This includes evaluating the patients reporting with symptoms related to asthma and wheeze and differentiating them from the patients suffering from any non-cardiac issue such as asthma, COPD (chronic obstructive pulmonary disease), pneumonia, ARDS (acute respiratory distress syndrome, etc).

Treatment of cardiac asthma includes steps and medication to improve the heart functioning.

Identifying the underlying cause is critical too so that it can be cured to manage the patient. E.g. if a patient is presenting with cardiac asthma due to underlying valvular heart disease, treatment of that disease through surgery or other procedures might be suggested.

Treatments include management of paroxysmal noctural dyspnea, orthopnea, edema and cardiac symptoms.

Treatment isn’t being given here in exact detail to discourage self medication. Please consult an expert for management. However, the treatment includes:

  • Elevate the head of the patient
  • Diuretics
  • Bronchodilators
  • Oxygen supplementation
  • Treatment of heart failure
  • Corticosteroids
  • Surgery or other procedures

Cardiac asthma is an emergency and if a patient suffers from any of the symptoms of cardiac asthma (or regular asthma), they should be rushed to emergency and managed accordingly.

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