Cardiac Asthma/Cardiac Wheezes By Matthew Mouser RRT This particular subject has always been extremely important, in my opinion, for anyone working in a critical care setting. When I first graduated from respiratory school in 2006, if I heard wheezing while listening to a patient`s breath sounds, I immediately associated it with asthma or some type of bronchoconstriction. Albuterol or Albuterol & Atrovent would be ordered for the patient every four hours and that was that. Little did I realize that a vast majority of the patients I treated had heart failure, fluid in their lungs, no history of lung disease or smoking, and what I assumed was wheezing from bronchoconstriction was in fact fluid in the patient’s lungs, mimicking bronchoconstriction. When a patient has heart disease such as congestive heart failure (CHF), fluid builds up in their lungs. If not properly treated with a diuretic this fluid builds up and can cause wheezing, very loud audible wheezing that in most cases can be heard without even using a stethoscope. Administering a bronchodilator is not the solution and in most cases is harmful for the patient. One of the side effects of a drug such as Albuterol is an increased heart rate, and anxiety. If a patient is having difficulty breathing due to heart failure, increasing their heart rate and causing them to be anxious is very detrimental to them. I have made it a personal mission to educate fellow Respiratory Therapists, Nurses and even Physicians about this particular subject, as it is commonly overlooked. Just because a patient is complaining of shortness of breath does not always mean they need a breathing treatment, and most of the time, in my experience, administering a breathing treatment has no positive effect on the patient’s respiratory status because they simply do not have a reactive airways disease that is treatable with a bronchodilator. To make matters worse, I have seen Physicians document in a patient’s chart that they have COPD! I have seen this done by residents who are still babies in the world of Physicians. This is now in that patient’s permanent record and it is false, inaccurate information! I have never quite understood how a Physician can have the audacity to diagnose a patient with COPD without that patient having had a pulmonary function test or having been evaluated by a Pulmonologist, or having any history that would indicate development of a chronic obstructive pulmonary disease. Education is the key here and ignorance is the culprit. Every day I learn something new and I am personally grateful for it. It is our duty as healthcare workers to constantly want to learn more and better our understanding of our chosen careers. I encourage each and every person working in healthcare to constantly attempt to better yourself as a practitioner in your particular field.