Cardiac Symptoms in Asthma Rarely Sign of Underlying Disease

Although patients with asthma may experience cardiac complications such as arrhythmias or chest pain, these symptoms are rarely the cause of underlying cardiac disease, according to study results published in the Journal of Asthma.

Researchers conducted a retrospective study that included 1296 patients aged 4 to 17 years who were admitted to a tertiary care center for asthma exacerbations between January 2012 and December 2016. Of the total cohort, 6% (n=77) received cardiac work-up, including electrocardiograms (n=65), echocardiograms (n=27), and cardiac enzyme tests (n=18). Chest pain, blood pressure abnormalities, tachycardia, arrhythmia, and syncope were the most common causes for cardiac work-up.

Among patients who received electrocardiograms, sinus tachycardia (n=44) was the most common finding, followed by nonspecific T wave, nonspecific ST segment, and T wave inversion. However, none of electrocardiograms obtained for chest pain reported clinically significant findings. Chest pain was mostly controlled with nonsteroidal anti-inflammatory drugs or acetaminophen, and patients with sinus tachycardia returned to their baseline rate on discharge.

Of the patients who received echocardiograms, 2 had a new diagnosis of hypertrophic cardiomyopathy, one had a vascular ring, and one had evidence of pulmonary hypertension. Meanwhile, abnormal elevations were discovered in 6 patients who received cardiac enzyme testing; 3 elevations were following cardiopulmonary arrest, 2 were from hypertrophic cardiomyopathy, and one was from low diastolic blood pressure and ST depression according to the electrocardiogram.

Among the 11 patients with blood pressure abnormalities, 10 had diastolic hypotension and one had persistent hypotension, but all 10 diastolic hypotension cases resolved at discharge.

Ultimately, only 2 of the patients (0.15%) who received cardiac work-up had intrinsic cardiac abnormalities (hypertrophic cardiomyopathy).

While the researchers found a low prevalence of underlying cardiac disease in pediatric patients with asthma, they acknowledged that there are instances when testing is warranted. “Recurrence of cardiac symptoms particularly after discontinuation of albuterol or during improvement of the acute exacerbation may warrant investigation,” they wrote. “Cardiac symptoms that cannot be explained by the asthma exacerbation or treatments should also be investigated.”

Several study limitations were noted, including the inability to describe the prevalence or incidence of cardiac symptoms in inpatient asthma, a lack of definitive causation, and a lack of longitudinal data.

Reference

Parlar-Chun R, Kakarala K, Singh M. Descriptions and outcomes of cardiac evaluations in pediatric patients hospitalized for asthma [published online July 22, 2019]. J Asthma. doi:10.1080/02770903.2019.1642353