Cardiac asthma

Description:

Cardiac asthma (cardial asthma) — drama manifestation of OLZhN. Systolic or diastolic dysfunction of a left ventricle is the cornerstone of its development. Usually note sharp decrease in sokratitelny function of a myocardium (for example when more than 20% of its weight drop out of process of reduction at a myocardial infarction), growth of filling pressure of LZh with the subsequent retrograde development of passive LG (hydrostatic pressure exceeds 28 mm of mercury. at first in pulmonary veins, and then and in arteries) and jamming pressure in LA (DZLA) more than 18 mm of mercury.

Symptoms of Cardiac asthma:

The clinical picture is characterized by development of a respiratory distress — emergence at night (during sleep) of dry cough, a tachypnea and the paroxysmal, accruing asthma or suffocation because in a prone position venous return of blood to heart, or in connection with the acute cordial accident arising at the patient with HSN amplifies. There is a bystry increase in load of the left departments of heart with which it does not cope. In addition during sleep sensitivity of TsNS decreases that worsens gas exchange in lungs, in a prone position there is no compensatory growth of ChD.
The attack sometimes quickly passes also without treatment ("thanks to an open window leaf"), but is, as a rule, inclined to drag on — of ten minutes till several o'clock. Character of attacks, weight of their current and the forecast are various. In one cases the attack of KA has "harbingers" (in the previous 2-3 days of the patient notes strengthening of an asthma and frequency of attacks of dry cough), and in others — no (as at a mitral stenosis).

The patient wakes up (often in fear), its breath becomes frequent (ChD to 30 — 40 respiratory movements in 1 min.) and superficial (as at "the overheated or tired out dog") because of irritation of a respiratory center. The patient holds forced position — an orthopnea (sitting, with the lowered legs), sometimes with the emphasis on hands for inclusion in the act of breath of auxiliary muscles that reduces stagnation of blood in a small circle of blood circulation. Appear (or amplify) heartbeat (ChSS more than 120-150 beats/min), strong feeling of shortage of air — an asthma of the inspiratory or mixed type (patients "catch air a mouth" and speak hardly), hoarse cough.

In the beginning it dry (an easy podkashlivaniye), becomes productive, with a small amount of a light phlegm, sometimes with blood streaks later. The ABP can be high, and then is sharp decrease in the eyes, signaling about a collapse.

If bystry rise in pressure in a small circle of blood circulation forms (more than 50 mm of mercury., what exceeds possibilities of a reflex of Kitayev), the bystry delay of liquid in an interstitium begins. It enters it, and cannot back return because of high venous pressure. A small amount of liquid comes also to a gleam of alveoluses because of what there is an organic blockade of gas exchange (between air and a capillary there is not only an epithelium, but also a liquid layer). It leads to the accelerating progressing of an asthma which till certain time actually is the compensatory mechanism.

Diagnosis includes various methods of a research. Objectively the person becomes pale with a cyanochroic shade, skin is covered with drops of cold sweat (it is caused by decrease in functioning of a myocardium of LZh and growth of sympathetic stimulation). The patient behaves uneasily, sometimes shows complaints to heartaches (if KA developed against the background of IT). On a breath retraction of intercostal spaces and supraclavicular poles — a sign of the high negative intrathoracic pressure necessary for breath is noted. Borders of heart are more often displaced to the left.

At heart auscultation (it is sometimes difficult because of a vizing and a lot of rattles) it is possible to reveal a symptom of that disease which served as OLZhN reason, dullness of cardiac sounds, accent of the 2nd tone over LA, a cantering rhythm. Pulse is frequent, weak filling, quite often alternating or threadlike. If there is no KSh, then the ABP raises in the beginning (as result of sympathetic stimulation), more rare remains normal, and then decreases.

When listening lungs in the beginning determine manifestations of a bronkhoobstruktivny syndrome (because of hypostasis mucous respiratory tracts) — the extended and noisy exhalation, "rigid" breath, single and scattered dry rattles (therefore such patients are often and dangerously confused to the patients suffering true OH) or short-term crepitation due to moistening by liquid of walls of alveoluses. Later there are not sonorous, single wet or crepitant rattles (because of emergence of a small amount of liquid in small bronchial tubes, bronchioles and alveoluses) in upper parts of lungs at once, and then — in zadnenizhny departments of lungs on both sides.

On a thorax X-ray analysis signs of venous stagnation, a plethora usually are defined; expansion of roots of lungs; an illegibility and strengthening of the pulmonary drawing (due to edematous infiltration of peribronchial interstitial fabric), Kerli striolas reflecting puffiness of interlobar partitions and elements of infiltration.

On an ECG amplitude of teeth, ST interval decrease, and also the changes characteristic of a basic disease are defined.

Reasons of Cardiac asthma:

Increase in permeability of pulmonary capillaries, decrease in oncotic pressure (the balance between oncotic and hydrostatic pressure both arteriolar and venous is broken) and to the subsequent transuding of elements of blood in intersticial fabric and to easy treatment of walls of alveoluses is observed. So appear puffiness mucous a bronchial tree (a prelum of bronchial tubes from the outside) and the subsequent bronkhoobstruktivny syndrome (is BAREFOOT).

Bronchioles (are in one intersticial bed with pulmonary capillaries) are squeezed, their mucous membrane bulks up, becomes edematous, as defines a clinical picture of cardial asthma.

Treatment of Cardiac asthma:

The main goal of treatment of cardiac asthma - to lower excitability of a respiratory center and to unload a small circle of blood circulation. However depending on a basic disease and features of a current the complex of medical actions can be various.

The patient needs to give sublime situation. Introduction of 0,5-1 ml of 1% of solution of morphine intravenously, intramusculary, subcutaneously (or fentanyl of 1-2 ml) in combination with 0,5 ml of 0,1% of solution of atropine is the most effective.

At tachycardia instead of atropine enter 1 ml of 1% of solution of Dimedrol or 1 ml of 2,5% of solution of Pipolphenum, or 1 ml of 2% of solution of Suprastinum. Administration of morphine is reasonable for removal of concern, but it can be dangerous because of development of a peripheral vazodilatation which strengthens a condition of a collapse, because of the bradycardia reducing a cordial output and because of the hypoxia connected with oppression of a respiratory center and a tendency to strengthening of a possible bronchospasm. Therefore, at hypotonia, disturbance of a respiratory rhythm (Cheyn-Stokes's breath), oppression of a respiratory center (breath becomes superficial, less frequent) morphine should not be entered. In similar situations it is more preferable to apply small tranquilizers (Relanium of 0,5% solution of 2 ml, Seduxenum of 0,5% solution of 2 ml), neuroleptics (2 ml of 2,5% of solution of Droperidolum against the background of the increased or normal arterial pressure).

At an arterial hypertension introduction of ganglioblokator is shown: 0,3-0,5 ml of 5% of solution of Pentaminum intramusculary or intravenously, арфонад intravenously kapelno - 250 mg for 5% glucose solution. It is necessary to enter Pentaminum and other ganglioblokator (petrolhexonium, Imechinum, Dimecolinum) into a vein very slowly (within 7-10 minutes) under constant control behind the level of arterial pressure.

Diuretics are shown with the normal or increased arterial pressure. Usually enter intravenously 60-80 haze-ziksa.

Administration of cardiac glycosides - 1-1,5 ml of 0,06% of solution of Korglykonum or 0,3-0,5 ml of 0,05% of solution of strophanthin - is shown after the specified therapy, generally at patients with a chronic heart disease, irrespective of the level of arterial pressure.

Let's notice that use of high-speed cardiac glycosides (strophanthin, Korglykonum, digoxin) is extremely dangerous at the cardiac asthma which developed at patients with a "pure" mitral stenosis. Why? Cardiac asthma and a fluid lungs at a mitral stenosis develop not owing to weakness of a myocardium, and because of sharp narrowing of a mitral orifice at good functional capacity of the right ventricle forcing blood in a small circle of blood circulation. Strengthening of sokratitelny function, a right ventricle can lead to increase in hydrostatic pressure in pulmonary capillaries. However, such idea of hemodynamic impact of cardiac glycosides on different departments of heart seems a little simplified and is not divided by many researchers.

Apply nitroglycerine on 0,5 mg under language to functional unloading of a myocardium, repeatedly in 10-15 minutes before achievement of effect (or by-effects). If there is Solution Nitroglycerini for parenteral use, then begin its drop introduction in a dose of 10 mg on 100 ml of 5% of solution of glucose, being guided by clinical effect and arterial pressure. At a bronkhospastichesky component it is reasonable to enter intravenously slowly 10 ml of 2,4% of solution of an Euphyllinum.