There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the Research
Definition of Cardiac Asthma
- Cardiac asthma, also known as acute pulmonary edema, is characterized by wheezing, coughing, and orthopnea due to congestive heart failure 1.
- It is often confused with bronchial asthma, but the clinical distinction can be made, especially in patients without chronic lung disease coexisting with left heart disease 1, 2.
Causes of Cardiac Asthma
- Pulmonary edema and pulmonary vascular congestion are thought to be the primary causes of cardiac asthma 1.
- However, circulating inflammatory factors and tissue growth factors, such as transforming growth factor-β, also contribute to airway obstruction 3.
- Cardiac dyspnea or asthma is a consequence of pulmonary edema due to pulmonary venous hypertension, not asthmatic bronchoconstriction 2.
Pathophysiology
- Cardiogenic pulmonary edema is characterized by the development of acute respiratory failure associated with the accumulation of fluid in the lung's alveolar spaces due to an elevated cardiac filling pressure 4.
- High capillary pressure can cause barrier disruption, leading to increased permeability and fluid transfer into the alveoli, resulting in edema and atelectasis 4.
- The breakdown of the alveolar-epithelial barrier is a consequence of multiple factors, including dysregulated inflammation, intense leukocyte infiltration, activation of procoagulant processes, cell death, and mechanical stretch 4.
Diagnosis and Treatment
- The correct approach to patients with cardiac asthma includes a detailed medical history and physical examination to evaluate signs and symptoms, as well as potential causes 4.
- Second-level diagnostic tests, such as pulmonary ultrasound, natriuretic peptide level, chest radiograph, and echocardiogram, should be performed 4.
- Treatment includes non-invasive ventilation, diuretics, and vasodilators for pulmonary congestion, and inotropes and vasopressors for hypoperfusion 4, 5.
- Patients with persistent symptoms and diuretic resistance may benefit from additional approaches, such as beta-agonists and pentoxifylline 4.