Cardiac asthma (SA) is characterized by a sudden onset, often at night. Its attack is caused by acute congestion of blood in the lungs due to a fall in the pumping function of the left ventricle of the heart or an obstacle to the outflow of blood from the left atrium (with mitral stenosis).
With cardiac asthma, the patient experiences a sensation of suffocation, often fear of death, seeks fresh air, moves into an upright position. Breathing is quickened, sometimes the bronchospastic component joins, which makes it difficult to differentiate with bronchial asthma (but there is no acute distention of the lungs). Often, cardiac asthma is accompanied by a cough.
An objective examination during an asthma attack: the patient’s skin is pale, moist rales are heard in the lower parts of the lungs, sometimes dry rales. It should be emphasized that physical changes in the lungs, as a rule, are more meager than with bronchial asthma. The pulse is frequent, often small.
The value of blood pressure depends on the cause of cardiac asthma: with hypertensive crisis it is high, with acute myocardial infarction, mitral stenosis – low. The duration of a heart attack, asthma from several minutes to several hours.
Pulmonary edema is the most severe and dangerous clinical variant of acute left ventricular failure. Its pathogenesis is similar to that of cardiac asthma. There is also a dissociation of the volumes of the right and left ventricles of the heart during blood pumping. However, an additional factor plays an important role – a pronounced increase in the permeability of vascular and cellular membranes in the lungs. Pulmonary edema can develop gradually, through the stage of cardiac asthma, or violently, suddenly.
The patient is pale , covered with sticky sweat, cyanosis is rapidly growing. Shortness of breath soon reaches severe degrees: breathing becomes shallow, difficult, foamy bloody sputum appears, sometimes in very large quantities (its volume can reach 2-3 l). The pulse is frequent, small filling, often arrhythmic. In the lungs, moist rales are heard. Blood hematocrit is increasing.
An X-ray examination revealed pulmonary congestion of the central type with a fan-shaped heavy structure of the pattern. Pulmonary edema most often develops with myocardial infarction., Hypertensive crisis, mitral stenosis.
Acute right ventricular failure , as already emphasized, is observed much less frequently than left ventricular failure . The clinic is characterized by a picture of shock in combination with pronounced shortness of breath. Respiratory rate usually exceeds 30-40 per minute. Cyanosis is rapidly growing. Partial pressure of oxygen drops in arterial blood and carbon dioxide grows.
Additional symptoms are caused by the pathological process that caused acute right ventricular failure. Very indicative are ECG changes that record acute overload of the right heart (McGene-White syndrome).
Acute cardiac circulatory failure is a direct threat to the patient’s life and requires emergency treatment in compliance with the following principles: 1) the start of treatment should be as early as possible; 2) the treatment should be different in intensity and be strictly adequate. This requires urgent hospitalization of patients, preferably in specialized institutions.
Adequacy of treatment is ensured only in conditions of constant clinical and laboratory instrumental monitoring. The goal of therapy is to ensure sufficient blood circulation by restoring the pumping function of the heart. The solution to this problem involves the creation of conditions for unloading a damaged heart and a direct enhancement of its inotropic function (“inotropic support” of the heart). In severe forms of OKNA, tissue perfusion recovery is necessary; the fight against acidosis, arrhythmias and pulmonary edema.