Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Cardiac asthma is a term used to describe asthma-like symptoms that can occur withleft-sided heart failure, a condition in which a lower chamber of the heart (called the left ventricle) is unable to pump blood efficiently. When this occurs, it can cause respiratory symptoms such as shortness of breath and wheezing that can easily be mistaken forasthma.
Jessica Olah / Verywell
Because the causes of asthma andheart failureare different, a correct diagnosis is vital: If cardiac asthma were to be treated with certain asthma medications, the heart failure may get worse.
Left-Sided vs. Right-Sided Heart Failure
Cardiac Asthma Symptoms
The respiratory symptoms of left ventricular failure can mimic those of asthma, particularly in the earlier stages of the disease. They may include:
Cough as a Symptom of Heart Failure
For some people, the respiratory symptoms of heart failure may be the first or most prominent symptoms. But, more often than not, they will occur alongside other symptoms, some of which may be missed or attributed to other causes, among them:
Symptoms like these, particularly ones that are persistent or worsening, can indicate something other than asthma is involved. Cardiac asthma is especially common in the elderly, nearly a third of whom will present with wheezing when first diagnosed.
Asthmaattackstend to develop and end abruptly, and the majority of people fully recover with no lasting effects. The chronic, progressive nature of heart failure is such that symptoms like shortness of breath, cough, and fatigue may improve for a short time, but will almost invariably persist until the appropriate treatment is received.
What Is Congestive Heart Failure?
Left-sided heart failure occurs when decreased cardiac output causes fluid to accumulate in the body. The backup of fluid into the lungs (calledpulmonary edema) can manifest with breathing problems as the airways and tiny air sacs of the lungs begin to fill with fluid.
While these effects may seem similar to those that occur with asthma, they are instead owed to inflammation and narrowing of the airways.
Certain risk factors also differentiate the two diseases. Broadly speaking, heart failure will usually occur with other chronic health conditions, such as:
Asthma, on the other hand, can affect even the most healthy of individuals.
Causes and Risk Factors of Heart Failure
Because the symptoms of cardiac asthma mimic those of true asthma, misdiagnosis is possible. A review of risk factors, medical history, andnon-respiratorysymptoms can suggest other possibilities.
Even if the initial symptoms point to a possiblediagnosis of asthma, an evaluation of lung sounds using a stethoscope can often differentiate asthma from other conditions like heart failure.
These sounds are not characteristic of asthma. Even during an attack, asthma chest sounds are usually limited to wheezing (a high-pitched whistling noise) during exhalation.
Lab Tests and Procedures
Based on initial findings, your healthcare provider will order tests to investigate further. If asthma is suspected, you would generally be referred to an allergist,pulmonologist, or pulmonology lab for evaluation with in-officespirometryand otherpulmonary function tests (PFTs).
If heart failure is suspected, a number of common lab tests, imaging studies, and procedures can be performed to confirm the diagnosis. You may get these initially or only after pulmonary tests have been conducted and reviewed:
It is important to seek a full and proper diagnosis of your condition whether heart failure or asthma is suspected.
A 2017 study in the journalJAMAreported that no less than 33% of adults previously diagnosed with asthma were, in fact, misdiagnosed. Of the 213 participants in the study, 12 were found to have a serious cardiorespiratory illness.
A diagnosis of asthma is complicated. If you’re being treated for asthma based on symptoms alone or with basic tests (like a peak flow meter orpulse oximetry), advocate for yourself and ask your healthcare provider about additional testing options.
How Heart Failure Is Diagnosed
The treatment of left-sided heart failure depends largely on the severity of the disease and the degree of cardiovascular impairment. Cardiac asthma symptoms may also be treated, but never in isolation.
The treatment of heart failure typically involves medications to improve cardiac output, reduce blood pressure, and alleviate structural stress in the affected ventricle. This alone can help relieve cardiac asthma symptoms in many people, particularly those with less severe disease.
Drugs commonly used to treat heart failure include:
What Is Diastolic Heart Failure?
Cardiac asthma symptoms may be directly treated but generally in those with advanced heart failure. There is no evidence thatshort-acting beta-agonists(a.k.a. “rescue inhalers”) relieve acute symptoms in people with cardiac asthma, so they are generally not useful.
People with cardiac asthma who are inappropriately treated with asthma medications run the risk of “masking” the symptoms of heart failure. Moreover, the use oflong-acting bronchodilators, often prescribed to people withpersistent asthma, may increase the cardiovascular risk in older people.
In more advanced cases, fluid aspiration (extraction with a needle) may be needed to relieve pressure on the heart. Intravenous nitrates (delivered via injection into a vein) may also be recommended along withoxygen therapy.
How Heart Failure Is Treated
A Word From Verywell
Cardiac asthma is a misleading term and one that highlights the confusion that can arise when diagnosing asthma-like symptoms. As a symptom of heart disease, cardiac asthma is not treated on its own. It requires the care of a cardiologist able to diagnose, treat, and manage left-sided heart failure. With appropriate care, the respiratory symptoms of heart failure can ease along with the other symptoms.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Tanabe T, Rozycki HJ, Kanoh S, Rubin BK.Cardiac asthma: New insights into an old disease.Expert Rev Respir Med. 2012;6(6):705-14. doi:10.1586/ers.12.67Tanabe T, Kanoh S, Moskowitz WB, Rubin BK.Cardiac asthma: transforming growth factor-β from the failing heart leads to squamous metaplasia in human airway cells and in the murine lung.Chest.2012;142(5):1274-83. doi:10.1378/chest.11-1710Jorge S, Becquemin MH, Delerme S, et al.Cardiac asthma in elderly patients: Incidence, clinical presentation and outcome.BMC Cardiovasc Disord. 2007;7:16. doi:10.1186/1471-2261-7-16Chahine J, Alvey H.Left ventricular failure. In: StatPearls.Hashmi MF, Tariq M, Cataletto ME.Asthma. In: StatPearls.Wang Z, Xiong YX.Lung sound patterns help to distinguish congestive heart failure, chronic obstructive pulmonary disease, and asthma exacerbations.Acad Emerg Med. 2012;19(1):79-84. doi:10.1111/j.1553-2712.2011.01255.xNagasaka Y.Lung sounds in bronchial asthma.Allergol Int.2012;61(3):353-63. doi:10.2332/allergolint.12-RAI-0449Inamdar AA, Inamdar AC.Heart failure: Diagnosis, management and utilization.J Clin Med.2016;5(7):62. doi:10.3390/jcm5070062Aaron SD, Vandemheen KL, Fitzgerald JM, et al.Reevaluation of diagnosis in adults with physician-diagnosed asthma. JAMA. 2017;317(3):269-79. doi:10.1001/jama.2016.19627Litzinger MHJ, Aluyen JKN, et al.Cardiac asthma: Not your typical asthma.US Pharm.2013;38(2):HS12-8.Gershon A, Croxford R, Calzavara A, et al.Cardiovascular safety of inhaled long-acting bronchodilators in individuals with chronic obstructive pulmonary disease.JAMA Intern Med.2013;173(13):1175-85. doi:10.1001/jamainternmed.2013.1016Miró Ò, Gil V, Peacock WF.Morphine in acute heart failure: good in relieving symptoms, bad in improving outcomes.J Thorac Dis. 2017;9(9):E871-4. doi:10.21037/jtd.2017.08.22
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Tanabe T, Rozycki HJ, Kanoh S, Rubin BK.Cardiac asthma: New insights into an old disease.Expert Rev Respir Med. 2012;6(6):705-14. doi:10.1586/ers.12.67Tanabe T, Kanoh S, Moskowitz WB, Rubin BK.Cardiac asthma: transforming growth factor-β from the failing heart leads to squamous metaplasia in human airway cells and in the murine lung.Chest.2012;142(5):1274-83. doi:10.1378/chest.11-1710Jorge S, Becquemin MH, Delerme S, et al.Cardiac asthma in elderly patients: Incidence, clinical presentation and outcome.BMC Cardiovasc Disord. 2007;7:16. doi:10.1186/1471-2261-7-16Chahine J, Alvey H.Left ventricular failure. In: StatPearls.Hashmi MF, Tariq M, Cataletto ME.Asthma. In: StatPearls.Wang Z, Xiong YX.Lung sound patterns help to distinguish congestive heart failure, chronic obstructive pulmonary disease, and asthma exacerbations.Acad Emerg Med. 2012;19(1):79-84. doi:10.1111/j.1553-2712.2011.01255.xNagasaka Y.Lung sounds in bronchial asthma.Allergol Int.2012;61(3):353-63. doi:10.2332/allergolint.12-RAI-0449Inamdar AA, Inamdar AC.Heart failure: Diagnosis, management and utilization.J Clin Med.2016;5(7):62. doi:10.3390/jcm5070062Aaron SD, Vandemheen KL, Fitzgerald JM, et al.Reevaluation of diagnosis in adults with physician-diagnosed asthma. JAMA. 2017;317(3):269-79. doi:10.1001/jama.2016.19627Litzinger MHJ, Aluyen JKN, et al.Cardiac asthma: Not your typical asthma.US Pharm.2013;38(2):HS12-8.Gershon A, Croxford R, Calzavara A, et al.Cardiovascular safety of inhaled long-acting bronchodilators in individuals with chronic obstructive pulmonary disease.JAMA Intern Med.2013;173(13):1175-85. doi:10.1001/jamainternmed.2013.1016Miró Ò, Gil V, Peacock WF.Morphine in acute heart failure: good in relieving symptoms, bad in improving outcomes.J Thorac Dis. 2017;9(9):E871-4. doi:10.21037/jtd.2017.08.22
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Tanabe T, Rozycki HJ, Kanoh S, Rubin BK.Cardiac asthma: New insights into an old disease.Expert Rev Respir Med. 2012;6(6):705-14. doi:10.1586/ers.12.67Tanabe T, Kanoh S, Moskowitz WB, Rubin BK.Cardiac asthma: transforming growth factor-β from the failing heart leads to squamous metaplasia in human airway cells and in the murine lung.Chest.2012;142(5):1274-83. doi:10.1378/chest.11-1710Jorge S, Becquemin MH, Delerme S, et al.Cardiac asthma in elderly patients: Incidence, clinical presentation and outcome.BMC Cardiovasc Disord. 2007;7:16. doi:10.1186/1471-2261-7-16Chahine J, Alvey H.Left ventricular failure. In: StatPearls.Hashmi MF, Tariq M, Cataletto ME.Asthma. In: StatPearls.Wang Z, Xiong YX.Lung sound patterns help to distinguish congestive heart failure, chronic obstructive pulmonary disease, and asthma exacerbations.Acad Emerg Med. 2012;19(1):79-84. doi:10.1111/j.1553-2712.2011.01255.xNagasaka Y.Lung sounds in bronchial asthma.Allergol Int.2012;61(3):353-63. doi:10.2332/allergolint.12-RAI-0449Inamdar AA, Inamdar AC.Heart failure: Diagnosis, management and utilization.J Clin Med.2016;5(7):62. doi:10.3390/jcm5070062Aaron SD, Vandemheen KL, Fitzgerald JM, et al.Reevaluation of diagnosis in adults with physician-diagnosed asthma. JAMA. 2017;317(3):269-79. doi:10.1001/jama.2016.19627Litzinger MHJ, Aluyen JKN, et al.Cardiac asthma: Not your typical asthma.US Pharm.2013;38(2):HS12-8.Gershon A, Croxford R, Calzavara A, et al.Cardiovascular safety of inhaled long-acting bronchodilators in individuals with chronic obstructive pulmonary disease.JAMA Intern Med.2013;173(13):1175-85. doi:10.1001/jamainternmed.2013.1016Miró Ò, Gil V, Peacock WF.Morphine in acute heart failure: good in relieving symptoms, bad in improving outcomes.J Thorac Dis. 2017;9(9):E871-4. doi:10.21037/jtd.2017.08.22
Tanabe T, Rozycki HJ, Kanoh S, Rubin BK.Cardiac asthma: New insights into an old disease.Expert Rev Respir Med. 2012;6(6):705-14. doi:10.1586/ers.12.67
Tanabe T, Kanoh S, Moskowitz WB, Rubin BK.Cardiac asthma: transforming growth factor-β from the failing heart leads to squamous metaplasia in human airway cells and in the murine lung.Chest.2012;142(5):1274-83. doi:10.1378/chest.11-1710
Jorge S, Becquemin MH, Delerme S, et al.Cardiac asthma in elderly patients: Incidence, clinical presentation and outcome.BMC Cardiovasc Disord. 2007;7:16. doi:10.1186/1471-2261-7-16
Chahine J, Alvey H.Left ventricular failure. In: StatPearls.
Hashmi MF, Tariq M, Cataletto ME.Asthma. In: StatPearls.
Wang Z, Xiong YX.Lung sound patterns help to distinguish congestive heart failure, chronic obstructive pulmonary disease, and asthma exacerbations.Acad Emerg Med. 2012;19(1):79-84. doi:10.1111/j.1553-2712.2011.01255.x
Nagasaka Y.Lung sounds in bronchial asthma.Allergol Int.2012;61(3):353-63. doi:10.2332/allergolint.12-RAI-0449
Inamdar AA, Inamdar AC.Heart failure: Diagnosis, management and utilization.J Clin Med.2016;5(7):62. doi:10.3390/jcm5070062
Aaron SD, Vandemheen KL, Fitzgerald JM, et al.Reevaluation of diagnosis in adults with physician-diagnosed asthma. JAMA. 2017;317(3):269-79. doi:10.1001/jama.2016.19627
Litzinger MHJ, Aluyen JKN, et al.Cardiac asthma: Not your typical asthma.US Pharm.2013;38(2):HS12-8.
Gershon A, Croxford R, Calzavara A, et al.Cardiovascular safety of inhaled long-acting bronchodilators in individuals with chronic obstructive pulmonary disease.JAMA Intern Med.2013;173(13):1175-85. doi:10.1001/jamainternmed.2013.1016
Miró Ò, Gil V, Peacock WF.Morphine in acute heart failure: good in relieving symptoms, bad in improving outcomes.J Thorac Dis. 2017;9(9):E871-4. doi:10.21037/jtd.2017.08.22
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