Cardiac Asthma

  • 1st Revision: Silvi Alex
  • 2nd Revision: Shagun Dhaliwal
  • 3rd Revision: Kaamya Mehta


Despite having the word ‘asthma’ in its name, cardiac asthma is not actually a type of asthma. Instead, it is a type of cough that occurs due to heart failure. It is called asthma due to the wheezing cough sound that is associated with bronchial asthma.

What Is Cardiac Asthma?

Cardiac asthma is a complication of left-sided heart failure due to pulmonary oedema and pulmonary hypertension. Due to the distinct wheezing cough associated with asthma, this condition is termed 'cardiac asthma'.

Causes Of Cardiac Asthma

Cardiac asthma is caused by a buildup of fluid in the lungs, known as pulmonary oedema. This fluid is a result of left-sided heart failure, which then causes pulmonary hypertension. Congestive heart failure involves the left ventricle of the heart being unable to pump blood properly. Excess fluid ends up in the pulmonary circulation.1

Typically, when individuals say they suffer from asthma, they refer to bronchial asthma. This is sometimes also referred to as ‘true asthma’ and is a chronic condition in which the airways become inflamed and narrow. It occurs following inhalation of irritants such as dust and air pollution.2 The treatment for true asthma and cardiac asthma vary significantly, so it is important to distinguish between the two conditions correctly. 

Risk Factors

Heart failure is defined as the heart not being able to meet the demands for blood and oxygen of the body. Because of this, risk factors for cardiac asthma are factors which may affect the proper functioning of the heart to meet the demands.2

  • High blood pressure
  • Diabetes
  • Diseased heart valves 
  • Congenital heart defects
  • Angina
  • Heart attack 

Signs And Symptoms Of Cardiac Asthma 

Cardiac asthma is described as having a distinct wheezing cough, similar to the cough associated with true asthma. This is arguably the biggest red flag for cardiac asthma, along with other symptoms such as:

  • Shortness of breath (dyspnea)
  • ​​Frothy and bloody sputum
  • Sweating 
  • Cyanosis
  • Enlarged heart

Symptoms tend to also worsen at night. They can be relieved by sitting up, as lying down also may make them worse.1 


The diagnosis of cardiac asthma involves understanding the patient’s medical history and performing a physical exam and diagnostic tests. With respect to medical history, as cardiac asthma is a secondary condition to heart failure, it often involves looking at the progression and symptoms of the heart failure.

Physical Exam

As well as a general check-up such as blood pressure and looking for symptoms of cardiac asthma, the physician will use a stethoscope to listen for rales

Diagnostic Tests

  • Chest X-Ray: looks at the fluid present in the lungs as well as the enlargement of the heart
  • ECG: abnormalities are seen in the ECG trace, supporting the idea that the heart is unable to pump blood efficiently.1 

Management And Treatment 

Management and treatment options for cardiac asthma are dependent on the cause, stage and severity of the heart failure.


Acute treatment drugs

For emergency cases of cardiac asthma, the drugs used may include furosemide (a diuretic to remove excess fluid), morphine and nitrates.1

However, ACE inhibitors and beta blockers may be used in the management of more chronic cases.

ACE Inhibitors

Angiotensin-converting enzyme (ACE) inhibitors are a type of drug used in the treatment or management of high blood pressure, heart failure as well as other related heart complications. This drug type works by inhibiting an enzyme in the body that produces angiotensin; this hormone narrows blood vessels which creates a higher blood pressure and therefore makes the heart exert more energy.3 

Beta Blockers 

Beta blockers are another class of drugs that may be used in cardiac failure with cardiac asthma symptoms. They work by lowering blood pressure by reversing the action of adrenaline, as well as widening blood vessels to decrease pressure and improve blood flow.4

Oxygen And Ventilation

Ventilation is a good short-term treatment option; however, it is unsustainable in the long term. Non-invasive ventilation is used to ensure that cardiac asthma patients aren’t deprived of oxygen in order to decrease the risk of mortality. This intervention is only used if signs of hypoxia are seen; when patients with dyspnea during the night are unable to alleviate symptoms by sitting up for 20-30 minutes, non-invasive oxygen may also be used.1 


Surgical intervention may be required for chronic cardiac asthma, meaning that the heart is constantly being overexerted. The surgical options are dependent on the cause of the heart failure. For example, if there is a problem with a heart valve, it will be replaced or repaired. If the heart is experiencing constant arrhythmias, a medical device such as a pacemaker will be inserted in order to allow the proper functioning of the heart. 5 


As mentioned previously, cardiac asthma is a consequence of heart failure. Because of that, lowering the risk of heart failure will lower the risk of cardiac asthma.

How Do I Reduce The Risk Of Cardiac Asthma?

This typically involves lifestyle changes:2

  • Managing chronic conditions to a good standard, such as hypertension and diabetes
  • Maintaining a healthy BMI
  • Avoiding excess stress
  • Maintaining a regular exercise regimen
  • Eating a well-balanced diet with lots of heart-healthy foods
  • Avoiding smoking and limiting alcohol 


The outlook for individuals with cardiac asthma is predominantly dictated by the stage of heart failure and their treatment options. Individuals who receive the correct treatment depending on the severity and the cause of the heart failure, are likely to have a positive outlook. 

The mortality rate for heart failure one year after diagnosis is 22%, whilst 5 years post-diagnosis is 43%. This shows the importance of early diagnosis and its effect on disease outlook. 6  


Cardiac asthma, a complication of heart failure, is caused by the buildup of fluid in the lungs. This fluid builds up due to pulmonary hypertension. Characterised by a wheezing cough, other symptoms also include dyspnea, with symptoms worsening at night.

Treatment options involve primarily treating heart failure. This can be done using medications such as furosemide (a diuretic to remove excess fluid), morphine and nitroglycerin. The other drugs that may be used are ACE inhibitors and beta blockers. In case the drugs are ineffective, an alternative form of treatment is oxygen ventilation;  in serious cases, surgery is used for heart failure but is dependent on the cause and stage. 

The risk factors for heart failure and cardiac asthma are similar (hence lifestyle modifications); taking the right medications and following the advice of the clinician regarding the treatment options will reduce the risk of further complications. 


  1. Litzinger M, Aluyen J, Cereceres R, Feik A, Iltis K, Perez C et al. Cardiac Asthma: Not Your Typical Asthma. US Pharmacist [Internet]. 2013;2(38):12-18. Available from:
  2. Cardiac Asthma: What Is It? [Internet]. Cleveland Clinic. Available from:
  3. What do ACE inhibitors do for heart health? [Internet]. Mayo Clinic. Available from:
  4. What you should know about beta blockers [Internet]. Mayo Clinic. Available from:
  5. Congestive Heart Failure Procedures | Cardiac Surgery | SUNY Upstate Medical University [Internet]. [cited 2022 Aug 16]. Available from:
  6. Malik A, Brito D, Vaqar S, Chhabra L. Congestive Heart Failure. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Aug 16]. Available from:
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Aisha Yasin

Biomedical Science - Biomedical Sciences, General, Lancaster University, England

"I am a recent biomedical science graduate, with ambitions to go on to do post-graduate medicine. During my biomedical science degree I have done a variety of modules including anatomy, physiology, clinical biochemistry and many more... Currently working as a healthcare assistant for P&O Cruises"

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