Cardiac asthma may occur in chronic cardiac patients when the underlying disease becomes decompensated, or as a manifestation of an acute cardiac condition, such as an extensive myocardial infarction that causes functional impairment of a large left ventricular mass. Such a patient will have bronchial hyper responsiveness [1] that is partially responsible for some elements of the clinical picture.

Cardiac asthma manifests as acute dyspnea and tachypnea that may progress to orthopnea and is accompanied by wheezing and dry cough. The patient may appear pale initially, but as the symptoms progress may become cyanotic. The episode may be more or less severe. The mildest form of cardiac asthma is represented by orthopnea. It is immediately relieved once the patient sits up straight in bed or on a chair for a few minutes (usually less than 10). Paroxysmal nocturnal dyspnea, the second stage in terms of severity, lasts for at least 30 minutes, even if the same position described above is assumed. It occurs during the night and symptoms wake the patient up. They consist of severe dyspnea, increased work of breathing, and gasping, causing anxiety. Acute pulmonary edema has the most dramatic presentation and the most severe origin: fulminant left ventricular failure. The patient appears very ill and experiences severe dyspnea and tachypnea. Hypoxia may cause restlessness or obnubilation, while poor peripheral perfusion may manifest as cold, sweaty extremities. The patient uses accessory respiratory muscles and experiences cough that is initially dry and subsequently becomes productive. The sputum is frothy and may contain blood.

During the acute episode, the patient may experience chest pain, usually caused by myocardial ischemia. Tachycardia diminishes the duration of the diastole and subsequently coronary filling time, also causing chest pain [2]. Palpitations can signify sinus tachycardia, atrial or ventricular arrhythmia.

Outside the acute dyspnea episode, the patient complains about other symptoms caused by chronic heart failure, such as fatigability, peripheral edema, oliguria, and nocturia.

Clinical examination of a cardiac asthma patient reveals an anxious, diaphoretic, pale or cyanotic individual, with labored breathing, tachycardia or gallop rhythm, cold extremities and elevated jugular venous pressure. Chronic heart patients may also have pleural effusion, making lung auscultation more difficult. When feasible, auscultation reveals the presence of basal crepitations. Wheezing can be heard in acute pulmonary edema cases. The Kussmaul sign (paradoxical rise in jugular venous pressure on inspiration) and hepatojugular reflux are present and the diastolic blood pressure may be slightly increased. The liver may be enlarged and painful.

Pulmonary and cardiac dyspnea can be rapidly differentiated by measuring the brain natriuretic peptide, which rises in heart failure patients [3]. After symptoms have subsided, pulmonary function testing can be performed to exclude respiratory dyspnea causes [4].

The electrocardiogram is often abnormal in heart failure patients, showing signs of acute or chronic myocardial ischemia, acute tachyarrhythmia or bradyarrhythmia or at least left atrial enlargement [5]. Systolic and diastolic functions are best evaluated by echocardiography, which is important because reduction of either of these parameters can be associated with cardiac dyspnea. This method also identifies the cause of the heart failure, such as valvular diseases or ischemia [6] [7]. Transesophageal echocardiography, if tolerated, is especially useful because it allows direct measurement of pulmonary capillary wedge pressures [8]. Genetic testing is indicated in cases of hypertrophic and dilated cardiomyopathy [9], arrhythmogenic right ventricular cardiomyopathy and left ventricular noncompaction.

The treatment of cardiac asthma focuses on managing the underlying heart failure. This may include:

• Diuretics: Medications that help remove excess fluid from the body.
• ACE inhibitors or ARBs: Drugs that help relax blood vessels and improve heart function.
• Beta-blockers: To reduce heart rate and blood pressure.
• Lifestyle changes: Such as reducing salt intake, maintaining a healthy weight, and regular exercise.
• Oxygen therapy: In severe cases, to help ease breathing.

The prognosis for cardiac asthma depends on the severity of the underlying heart failure and how well it is managed. With appropriate treatment, symptoms can be controlled, and quality of life can be improved. However, if left untreated, cardiac asthma can lead to serious complications, including worsening heart failure and increased risk of hospitalization.

Cardiac asthma is primarily caused by left-sided heart failure, where the left ventricle of the heart is unable to pump blood effectively. This leads to increased pressure in the pulmonary veins, causing fluid to leak into the lungs. Conditions that can lead to heart failure include coronary artery disease, high blood pressure, heart valve disorders, and cardiomyopathy.

Cardiac asthma is more common in older adults, as the risk of heart failure increases with age. It is also more prevalent in individuals with a history of heart disease, high blood pressure, or diabetes. The exact prevalence is difficult to determine, as it is often underdiagnosed or misdiagnosed as bronchial asthma.

In cardiac asthma, the heart's inability to pump blood efficiently leads to increased pressure in the pulmonary circulation. This pressure causes fluid to seep into the alveoli, the tiny air sacs in the lungs, resulting in pulmonary edema. The presence of fluid in the lungs triggers wheezing and shortness of breath, similar to the symptoms of bronchial asthma.

Preventing cardiac asthma involves managing risk factors for heart failure. This includes:

• Controlling high blood pressure and cholesterol levels.
• Maintaining a healthy weight and diet.
• Regular physical activity.
• Avoiding smoking and excessive alcohol consumption.
• Regular medical check-ups to monitor heart health.

Cardiac asthma is a condition characterized by asthma-like symptoms due to heart failure. It is important to differentiate it from bronchial asthma to ensure appropriate treatment. Management focuses on treating the underlying heart failure and may involve medications, lifestyle changes, and in some cases, oxygen therapy. Early diagnosis and treatment are crucial for improving outcomes and quality of life.

If you experience symptoms such as wheezing, shortness of breath, or difficulty breathing, especially at night, it is important to seek medical evaluation. These symptoms could be indicative of cardiac asthma, a condition related to heart failure. Understanding the difference between cardiac and bronchial asthma is essential for receiving the correct treatment. Managing heart health through lifestyle changes and medication can help control symptoms and improve overall well-being.

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