CARDIAC ASTHMA (asthma cardiale; Greek asthma an asthma, a pant) — the attack of the short wind reaching degree of suffocation, caused by development of insufficiency of the left departments of heart.
Asthma is mentioned in treatises of Ancient Greek doctors. This state was studied by K. Galen, A. Tseljs, etc., however they did not distinguish S. and. from other types of suffocation. In 1715 Mr. A. Vieussens for the first time connected developing of short wind with stagnation in a small circle of blood circulation. Detailed description of an attack of S. and. it is provided in Houp's works (J. To a hole, 1832), and then L. Traube (1878), S. seeing the reason and. in acute weakness of a left ventricle and dissociation in work of both ventricles. L. V. Popov (1902), G.F. Lang (1936), A adhered to the same point of view. L. Myasnikov (1952), P. Whyte (1929), etc. According to Plotts (M. of P. Plotz, 1947), Coen (E. J. Cohen, 1950), M. Ya. Aryeva (1962), is the reason of suffocation an acute spasm of bronchial tubes.
Page and. meets at coronary heart disease (see), myocardites (see), valve heart diseases (see. Heart diseases inborn , Heart diseases are acquired e), arterial hypertension (see. arterial hypertension ), at acute and chronic glomerulonephritis (see), etc.
S. and. it is caused by acute intersticial hypostasis of pulmonary fabric, in the mechanism of development to-rogo play a role an acute left ventricular failure at safe function of a right ventricle and increase in volume of the blood coming to a small circle of blood circulation. Its defeat can be the cause of insufficiency of a left ventricle at a myocardial infarction, myocarditis or deterioration in coronary blood supply at stenocardia, and also the significant increase in loading exceeding reserve opportunities of a myocardium of the patient (at hypertensive crisis, a physical or psychoemotional overstrain). The special conditions promoting emergence of an attack of S. and., are created at a mitral stenosis in connection with insufficient filling of a left ventricle and it is essential supertension in the left auricle. If at the same time there is exhaustion of a protective reflex of Kitayev (see. Kitayeva reflex ), overflow by blood of pulmonary capillaries and a vein of l, an acute intersticial fluid lungs, the shown wedge, a picture C. is possible and.
Great value for emergence of an attack of S. and. has increase in volume of the circulating blood. At hidden or explicit heart failure (see) the patient in horizontal position has a mobilization of hypostases that leads to strengthening of inflow of blood to a right ventricle, increase in the central venous pressure, and also stroke and minute output of a right ventricle. If at the same time there is no adequate increase in emission from a left ventricle, conditions for development of an attack of S. are created and. At patients with an acute and chronic glomerulonephritis to development of an attack of S. and. arterial hypertension * and a hyper-ox an emiya promotes. Activation sympaticoadrenal and a renin-angiotenzinovoy of systems at stressful states (see. Stress ), leading to increase in peripheric resistance, increase in need of fabrics for oxygen and the increased load of a myocardium, can provoke development of attacks of S. and. at persons with heart diseases. It is promoted by a konstriktion of large veins and increase in a venous inflow of blood, and also increase in permeability of pulmonary membranes. Owing to discrepancy of amount of the blood getting to vessels of a small circle of blood circulation, to opportunities of its outflow pressure in the left auricle increases, outflow of blood on pulmonary veins is broken, intra capillary hydrostatic pressure increases. It leads to transudation of liquid in intersticial fabric. Peribronchial hypostasis causes a prelum of small bronchial tubes in nek-ry patients joins bronchospasm (see). Perivascular hypostasis complicates perfusion of gases and gas exchange. The arising ventilating and perfused disturbances lead to excitement of a respiratory center and to an asthma (see).
Page and. develops at advanced age more often. At patients with heart diseases, S.'s glomerulonephritis and. can arise at young and children's age. As a rule, S. and. it is observed at the patients suffering from any displays of heart failure and stagnation in a small circle of blood circulation. Page and. develops at any time, is more often at night. The beginning of an attack usually sudden, sometimes with the prodromal stage preceding it in the form of discomfort of breath, heartbeat (see), constraint in a breast. The patient wakes up in cold sweat with feeling of sharp shortage of air; an asthma reaches degree of suffocation. The attack can be followed by fear of death. There is continuous dry cough, and at development of alveolar hypostasis the liquid foamy pink phlegm is allocated. An asthma forces the patient to reach a sitting position — an orthopnea, a cut facilitates its state thanks to deposition of blood in the lower extremities and vessels of an abdominal cavity. Sometimes patients get up and approach an open window.
At survey pallor, a Crocq's disease, shallow frequent breathing are noted (to 30 and more in 1 min.). Perkutorno comes to light obtusion of a pulmonary sound in lower parts of lungs or its bandbox shade at accession of a bronchospasm. Auskultativno is found rigid breath, in lower parts — wet small-bubbling rattles. In some cases at a prolonged attack breath can become spasmodic (wavy). These auscultations of heart depend on a basic disease. At an attack there can be a cantering rhythm (see. Gallop rhythm ), emphasis of the II tone on a pulmonary artery, tachycardia to 120 blows and more in 1 min. (see. Tachycardia ), premature ventricular contraction and other disturbances of a rhythm. At ciliary arrhythmia (see) deficit of pulse increases, the ABP usually raises. Increase in venous pressure, delay of speed of a blood-groove, swelling of cervical veins in connection with increase in intrathoracic pressure is noted. At rentgenol. a research symptoms of hypertensia in system of a pulmonary artery come to light (see. Hypertensia of a small circle of blood circulation ): strengthening of the vascular drawing, in the beginning in upper, then in the central and lower parts of pulmonary fields, expansion of roots of lungs, a trunk of a pulmonary artery and its branches. At a research of functions of external respiration find decrease vital capacity of lungs (see), tachypnea (see), shortening of duration and difficulty of a breath (inspiratory nature of short wind). At accession of a bronchospasm the exhalation becomes longer than a breath, an asthma gains expiratory character. On an ECG (see. Elektrokardiografiya ) signs of disturbance of coronary circulation can be revealed (see. Coronary insufficiency ), disturbance of intra ventricular conductivity, arrhythmia. At a research of phase structure of heart (see. Heart, physiology ) lengthening of the period of tension and shortening of a sphygmic interval, sharp shortening of a diastole is found. Cordial emission in comparison with the mezhpristupny period decreases. In blood find a tendency to metabolic to acidosis (see); respiratory is possible alkalosis (see) owing to a hyperventilation. The structure of blood gases usually does not change.
Duration of an attack of S. and. — of several minutes till several o'clock. In rather mild cases the small equivalent of an attack is observed: the paroxysmal dry cough (usually at night) forcing the patient to sit down in beds, heartbeat, feeling of constraint in a breast. In hard cases S.'s attack and. can pass in fluid lungs (see).
S.'s Treatment and. reduction of volume of the circulating blood and a venous inflow of blood to the right heart, dehydration of lungs, reduction of loading of a left ventricle, strengthening of its sokratitelny ability is directed to decrease in hydrostatic pressure in vessels of a small circle of blood circulation. The specific plan of measures in many respects is defined by a basic disease and features of its current. The patient needs to give a comfortable position (to put), impose plaits on legs or to make hot foot baths for the purpose of deposition of blood and reduction of its inflow to a right ventricle. At the expressed arterial hypertension gangliobloka-Torahs, the reducing ABP and the general peripheric resistance (intravenously slowly Pentaminum, benzogek-sony, gigrony or kapelno arfo-over), under control of the ABP are shown; alpha adrenoblockers (phentolamine); the neuroleptics (Droperidolum, etc.) promoting redistribution of blood and decrease in arterial and venous pressure; narcotic analgetics (morphine, fentanyl) increasing the capacity of a peripheral vascular bed, the reducing ABP and the venous inflow to the right heart which is reducing an asthma, removing alarm and fear of death. At S. and. also apply high-speed diuretic — intravenously to a lazika (furosemide), Uregitum (ethacrynic to - that). In the absence of diuretic effect for reduction of an asthma, decrease in the ABP and load of a left ventricle appoint the peripheral vazodilatator (e.g., Sodium nitroprussidum) causing decrease in venous return to heart and reducing a krovenapolneniye of vessels of a small circle of blood circulation. Cardiac glycosides are shown (0,05% solution of strophanthin intravenously), at appointment to-rykh it is necessary to consider decrease in tolerance to them in the acute period of a myocardial infarction. For strengthening of sokratitelny ability of a left ventricle intravenously kapelno enter a glucagon on isotonic solution of sodium chloride; at the expressed disturbance of bronchial passability and a bronchospasm — intravenously an Euphyllinum. Apply inhalations of oxygen to fight against a hypoxia.
For the prevention of attacks of S. and. are necessary rational treatment hron. heart failure, a diet with restriction of liquid (especially in the evening) and salts, use of sedatives. Patients with heart diseases should avoid physical and psychoemotional overworks.
Bibliography: Badalyan G. O. and Topchyan A. S. Cardiac asthma, Yerevan, 1978; Mukharlyamov N. M., Ma-reev V. Yu. and Ataullakhano-v and D. M. Possibilities of use of peripheral vazodilatator at cardiac asthma and the menacing fluid lungs, Rubbed. arkh., t. 52, No. 10, page 70, 1980; V. G. Priests and T about p about l I am a N with to and y V. D. Fluid lungs. M. 1975; The Guide to cardiology, under the editorship of E. I. Chazov, t. 3, page 573, M., 1982; Smetnev A. S. and Petrova L. N. Medical emergencies in clinic of internal diseases, page 72, M., 1977; Budelmann I. Das Asthma cardiale, Internist, Bd 12, S. 52, 1971.
E. I. Sokolov, I. E. Sofiyeva.