Episode 957: Cardiac Asthma
Emergency Medical Minute19 Maj 2025

Episode 957: Cardiac Asthma

Contributor: Travis Barlock, MD
Educational Pearls:

  • Wheezing is classically heard in asthma and COPD, but it can be the result of a wide range of processes that cause airflow limitation
    • Narrowed bronchioles lead to turbulent airflow → creates the wheezing
  • Crackles (rales) suggest pulmonary edema which is often due to heart failure
  • Approximately 35% of heart failure patients have bronchial edema, which can also produce wheezing
  • COPD and heart failure can coexist in a patient, and both of these diseases can cause wheezing
    • It's vital to differentiate whether the wheezing is due to the patient's COPD or their heart failure because the treatment differs
  • Diagnosing wheezing due to heart failure (cardiac asthma):
    • Symptoms: orthopnea, paroxysmal nocturnal dyspnea
    • Diagnostic tools: bedside ultrasound
    • Treatment: diuresis and BiPAP for respiratory support
  • Not all wheezing is asthma
    • Consider heart failure in the differential and tailor treatment accordingly

References
1. Buckner K. Cardiac asthma. Immunol Allergy Clin North Am. 2013 Feb;33(1):35-44. doi: 10.1016/j.iac.2012.10.012. Epub 2012 Dec 23. PMID: 23337063.

2. Hollingsworth HM. Wheezing and stridor. Clin Chest Med. 1987 Jun;8(2):231-40. PMID: 3304813.

Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3

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