Emergency Medical Minute Episode 957: Cardiac Asthma
May 19, 2025
Explore the intriguing concept of cardiac asthma, a condition often confused with COPD. Discover how narrowing bronchioles lead to wheezing and the significance of crackles indicating pulmonary edema. Learn that about 35% of heart failure patients may experience bronchial edema, complicating diagnosis and treatment. Find out why it's essential to differentiate between COPD and heart failure wheezing for effective management, including the role of bedside ultrasounds and treatment strategies like diuresis and BiPAP.
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Wheezing Mechanism and Heart Failure
- Wheezing is caused by narrowed bronchioles creating turbulent airflow that produces the wheezing sound.
- Crackles typically suggest pulmonary edema linked to heart failure, but wheezing can also be from bronchial edema in heart failure.
Differentiate Cardiac Asthma from COPD
- Don't assume wheezing always means asthma or COPD; consider heart failure as a cause, called cardiac asthma.
- Tailor treatment based on cause, since heart failure needs diuresis and respiratory support, unlike COPD.
Assessing and Managing Cardiac Asthma
- Ask about orthopnea and paroxysmal nocturnal dyspnea to assess for heart failure in wheezing patients.
- Use bedside ultrasound and start diuretics promptly if heart failure is confirmed.