Dyspnoea in cardiac asthma (paroxysmal nocturnal dyspnea)

Proven content

Dyspnoea in cardiac asthma is the colloquial term for the medical condition of which is paroxysmal nocturnal dyspnea. The disease is caused by a sudden weakening of the left ventricle with normal or sometimes excessive right ventricular function; this leads to congestion in the lungs. Attacks of this type of breathlessness occur in people suffering from various heart ailments, such as e.g. myocarditis, heart defects, coronary insufficiency. Dyspnoea usually occurs at night.

Dyspnoea in cardiac asthma – what is it?

Dyspnoea in cardiac asthma is known as cardiac asthma, characterized by the occurrence of dyspnea due to chronic insufficiency of the left ventricle. This kind of ailment may appear especially at night, while sleeping. Then the patient is awakened and takes a sitting or standing position, thanks to which the dyspnea disappears after about 30 minutes. Dyspnoea in cardiac asthma may be associated with poor tolerance to exercise, dry cough or excessive sweating.

Principles of blood circulation

If you want to understand the mechanism of breathlessness in cardiac asthma, you should learn about the principles of blood circulation in the body. It is worth knowing that blood circulation takes place in a closed system, more precisely:

1. in the large (systemic) bloodstream – here, oxygenated blood flows from the left ventricle into the aorta, and then reaches selected organs and tissues, supplying them with oxygen. Finally, the blood with a small amount of oxygen returns through the veins to the right atrium of the heart, from which it enters the right ventricle;
2. in the small bloodstream (pulmonary) – blood is pumped from the right ventricle of the heart to the pulmonary trunk, from which it enters the lungs and alveoli, where it is oxygenated. It then reaches the left atrium and the left ventricle through the pulmonary veins.

The causes of dyspnea in bronchial asthma

The dyspnea that occurs in left ventricular failure results from blood stagnation in the pulmonary circulation. Then lung congestion occurs because the malfunctioning left ventricle is unable to pump all the blood that flows into it from the pulmonary circulation. Importantly, failure of one ventricle may be accompanied by failure of the other.

While the patient is lying down, the effect of gravity is reduced, which causes that a certain amount of blood from the internal organs and lower limbs to the chest. The vital capacity of the lungs is reduced by approximately 25%.

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Other causes that contribute to the development of dyspnea in bronchial asthma include:

1. interstitial lung discomfort,
2. chronic obstructive pulmonary disease,
3. sometimes asthma,
4. bronchiectasis
5. obstructive sleep apnea,
6. poorly tolerated physical effort,
7. lying position, in which the muscles work worse.

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Dyspnoea in bronchial asthma – symptoms

The patient usually wakes up from sleep with a feeling of severe shortness of breath, anxiety, general weakness and fear of suffocation. Then he sits down on the bed and props himself with his hands or goes to the window to get some fresh air. The patient’s breathing increases rapidly, and sometimes there is pain in the heart area. The sick man is pale, drenched in cold sweat. Sometimes a slight cyanosis appears. An attack of breathlessness usually lasts 20–40 minutes and is often self-limiting.

Left ventricular failure associated with congestion in the pulmonary circulation is additionally manifested by:

1. dry cough
2. expectoration (sometimes) of pink sputum, which may indicate pulmonary edema, which is a life-threatening condition,
3. the presence of crackling and wheezing over the lung fields (during auscultation),
4. confusion
5. pale skin of the limbs,
6. cold skin of the limbs,
7. less tolerance of physical effort.

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If the dyspnea in bronchial asthma is prolonged and worsening, you should call for medical help immediately. An indication to call a doctor immediately is heavy, wheezing breath (as if something is “boiling in the lungs”), cyanosis, profuse sweating and possibly spitting out a large amount of foamy – sometimes pink-colored – sputum. This is suggestive of pulmonary edema beginning.

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Until the doctor arrives:

1. put the patient in the most comfortable position for him in bed (i.e. a sitting position, with the possibility of leaning on high pillows),
2. ventilate the apartment / room where the patient is,
3. give the patient oxygen to breathe (if possible).

The non-pharmacological methods of treating dyspnoea in cardiac asthma include:

1. quitting smoking;
2. reducing alcohol consumption;
3. restriction in the diet of table salt and products containing a large amount of salt;
4. reduced fluid intake in patients who retain water in the body;
5. weight control (obese people should eat better and reduce their weight);
6. limiting the intake of non-steroidal anti-inflammatory drugs that can cause water retention in the body;
7. practicing physical activity (moderate and well-suited to the patient);
8. vaccination against influenza and pneumococci.

However, in pharmacological treatment, patients are recommended to use diuretics, angiotensin converting enzyme inhibitors and β-blockers. Sometimes invasive treatment is necessary.

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