Wheezing, coughing, breathlessness: Cardiologist Dr Binay Kumar explains the lesser-known signs of heart failure

Wheezing, coughing and breathlessness may not always be asthma. Cardiologist explains how heart failure can cause similar symptoms, known as cardiac asthma.

Wheezing, coughing and breathlessness are commonly associated with asthma. However, these symptoms can sometimes have a different cause: heart failure. This condition, often referred to as cardiac asthma, occurs when fluid builds up in the lungs because the heart is unable to pump blood effectively.

In an interview with HT Lifestyle, Dr Binay Kumar, Director-Interventional Cardiology & Electrophysiology, Yatharth Super Speciality Hospital, Sector 88, Faridabad, explained how cardiac asthma differs from conventional asthma, its warning signs, diagnosis and treatment.

What is cardiac asthma?

“Cardiac asthma is not a type of asthma; it’s an episode of breathing difficulty as a result of heart failure. When it’s left heart failure, it leads to congestion in the lungs. These conditions in the lungs increase when you lie down during the night,” Dr Kumar says.

He explains that when the left side of the heart is weak, fluid can build up in the lungs, resulting in breathing difficulty. “In people who have heart problems and go into heart failure, even low-grade heart failure, there’s fluid that gets into the lungs and fluid that gets into the airway. Therefore, people start experiencing wheezing, cough and shortness of breath. That’s not really due to asthma, but it occurs owing to the heart,” he adds.

How is cardiac asthma different from regular asthma

According to Dr Kumar, conventional asthma occurs because of bronchospasm, where the airways narrow and cause wheezing. “Asthma is a condition where the airways go into spasm, or the airways are narrowed, and when we breathe in and breathe out, we hear wheezing noises. We have an obstruction to the airflow,” he explains.

Asthma can be triggered by allergies, pollen, air pollution, seasonal changes or changes in weather. Some people may also develop intrinsic asthma, where the airways intermittently go into spasm without an obvious external trigger. Cardiac asthma, on the other hand, is linked to heart failure and fluid accumulation in the lungs.

Asthma is a chronic condition of the lower airways, the bronchial tubes in the lungs. (Unsplash)

Symptoms of cardiac asthma

The symptoms of cardiac asthma can closely resemble those of bronchial asthma, making the condition difficult to identify.

Common symptoms include:

• Breathing difficulty
• Wheezing
• Rapid breathing
• Persistent coughing
• Bloody or frothy sputum
• Grunting while breathing
• Shortness of breath while lying down, known as orthopnea
• Waking up at night gasping for air, known as paroxysmal nocturnal dyspnea
• Abnormal sounds from the chest, known as rales

Dr Kumar says people experiencing these symptoms should consider whether an underlying heart problem could be responsible. “If you are coughing, wheezing and having shortness of breath, always think of possibilities. Is my heart functioning well? Have I got edema of the lower extremities? Do I get chest discomfort, chest pain, heart rhythm problems? If you have those, think about maybe it’s your heart that’s the cause of your wheezing,” he says.

Who is at risk of cardiac asthma

People with certain health conditions may be more likely to develop cardiac asthma, particularly those that increase the risk of heart disease and eventual heart failure.

These include:

• High blood pressure
• Diabetes
• Abnormal heart rhythms
• Hypothyroidism
• Other underlying heart conditions

Why cardiac asthma can be misdiagnosed

Since the symptoms of cardiac asthma overlap with conventional asthma, diagnosis can sometimes be challenging. “Diagnosis of cardiac asthma is crucial as it points out congestive heart disease. It’s quite difficult to figure out due to the signs matching those of asthma. Because of this, cardiac asthma is often misdiagnosed, which can turn life-threatening,” Dr Kumar says.

Doctors may conduct a physical examination followed by blood tests and cardiac investigations such as an electrocardiogram (ECG) and echocardiogram. A chest X-ray may also be performed to check for heart enlargement or signs of fluid accumulation. Depending on the case, CT scans or MRI may be recommended for further evaluation.

Cardiac asthma differs from bronchial asthma due to its connection with heart failure. (Pexels)

Treatment is different from asthma

Because the underlying causes are different, cardiac asthma and bronchial asthma require different treatments. “In cardiac asthma, you have fluid in the lungs, so the patients are given a diuretic to flush out the extra fluid from the lungs and also given medications to minimise the load on the heart. This is how we treat heart failure,” Dr Kumar explains.

In conventional allergic asthma, treatment may include bronchodilators to open the airways, anti-inflammatory inhalers to reduce airway swelling, and anti-leukotriene or other anti-allergy medicines. Nebulisers may also be used to deliver medication when inhalers are difficult to administer.

How to prevent cardiac asthma

Since cardiac asthma is associated with heart failure, managing cardiovascular risk factors is important. Dr Kumar recommends:

• Keep blood pressure, diabetes and cholesterol under control through regular exercise and a balanced diet.
• Take prescribed heart medicines regularly and do not stop diuretics, blood pressure medicines or other cardiac medicines without medical advice.
• Limit salt intake, particularly if you have heart failure or swelling, as excess sodium can cause fluid retention.
• Avoid smoking and secondhand smoke.
• Exercise regularly and maintain a healthy weight, as advised by your doctor.

“It’s advisable to consult a cardiologist and get that correct,” Dr Kumar says, particularly when wheezing or breathlessness occurs alongside swelling in the legs, chest discomfort, chest pain or heart rhythm problems.

Dr Binay Kumar specialises in treating heart-related problems and has over 15 years of experience in cardiology, interventional cardiology, and electrophysiology. He is an expert in complex angioplasty, managing arrhythmias, and pacemakers.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.