COPD and Heart Failure

Chronic obstructive pulmonary disease (COPD) and heart failure both cause difficulty breathing. For people who have both COPD and heart failure, identifying the cause of breathing symptoms can be challenging. Symptoms of COPD and Heart Failure

COPD and heart failure cause the same main symptom: shortness of breath with exertion. People with COPD, heart failure, or both have a limited ability to exercise, climb stairs, or walk long distances. Difficulty breathing occurs for different reasons in COPD and heart failure. People with COPD have difficulty exhaling all the air in their lungs because of lung damage -- often from years of smoking. When it takes longer to exhale completely, its hard to increase the rate of breathing. Most people with COPD breathe comfortably while resting. During exertion, though, breaths start coming in before air from the last breath has been exhaled, and shortness of breath results. In people with heart failure, the heart does not pump blood efficiently. As in COPD, most people with heart failure can breathe easily when at rest. With activity, blood flow must increase, and the heart must pump harder and faster. If the heart cant keep up, blood backs up into the lungs. This fluid congestion causes shortness of breath.
COPD and Left-Sided Heart Failure

Heart failure in the left ventricle is the most common form of heart failure. Left-sided heart failure is most often caused by high blood pressure or coronary artery disease. COPD and left-sided heart failure are not directly related. However, the two conditions may influence each other. For example, low oxygen in the blood from COPD may put excess strain on the heart, worsening left-sided heart failure. Excess fluid in the lungs from heart failure can make breathing even more difficult for someone with COPD.
COPD and Right-Sided Heart Failure

Severe COPD can cause heart failure in the hearts right ventricle, a condition called right-sided heart failure or cor pulmonale. In severe COPD, oxygen concentration in the blood falls to abnormally low levels. In response, the walls of the main blood vessels inside the lungs (pulmonary arteries) experience changes. The blood pressure inside these arteries goes up as well. This is one type of a condition called pulmonary hypertension. The hearts right ventricle pumps blood through the pulmonary arteries into the lungs. High blood pressure in the pulmonary arteries puts excess strain on the right ventricle. Over time, the right ventricle may become stretched and dilated, and fail to pump blood effectively.

Right-sided heart failure causes fluid to accumulate in the body, such as in the legs and abdomen. Many conditions other than COPD also cause pulmonary hypertension and right-sided heart failure.
Telling the Difference Between COPD and Heart Failure

When someone with both COPD and heart failure experiences shortness of breath, identifying which condition is causing the symptoms can be difficult. Most people with both COPD and heart failure cannot distinguish between the symptoms of each condition.
Telling the Difference Between COPD and Heart Failure continued...

Doctors cannot consistently or accurately tell the two apart, either. When someone with both heart failure and COPD seeks help for breathing difficulty, a doctor may use various tests to gauge the activity of each condition, including:

Physical examination: Listening to the lungs and heart, and looking at the veins in the neck, can give a doctor reason to suspect COPD or heart failure. Chest X-ray: Heart failure may cause fluid in the lungs to be visible on a chest X-ray; in COPD, the lungs are usually clear. Brain natriuretic peptide (BNP): This hormone is usually elevated on blood tests in people with heart failure, whether or not COPD is also present. Pulmonary function tests: Breathing tests can be used to diagnose people with COPD. Echocardiogram: An ultrasound test of the heart that can evaluate the heart chambers, valves, and pumping strength. Cardiac enzymes: This blood test can help diagnose a heart attack or excessive heart strain.

Some people have severe COPD and only mild heart failure; others have severe heart failure and only mild COPD. In these cases, the more severe condition is more likely to be the cause of symptoms. In people with COPD and heart failure of about equal severity, doctors must make their best guess as to which condition is causing symptoms. Making things even more complicated, COPD and heart failure can at times act up simultaneously. For example, if someone has worsening heart failure symptoms that cause rapid breathing, this can cause COPD symptoms to worsen as well.

Treating COPD and Heart Failure

If doctors cannot reliably distinguish between shortness of breath from CHF and COPD, both conditions are often treated together. Treatments for COPD focus on the lungs and the airways, the branching network of tubes inside the lungs. The main treatments for COPD are bronchodilators, inhaled medicines that help open the airways. Heart failure treatments reduce the workload on the heart and help prevent unhealthy growth of heart muscle. Categories of treatments for heart failure include:

Diuretics, which increase urination and reduce the heart strain from fluid overload. Beta-blockers, which prevent excessive stress on the heart and reduce blood pressure. However, these would not be used if a person is having an acute episode of heart failure. Angiotensin-converting enzyme inhibitors, which lower blood pressure and reduce heart stress. Other blood pressure medicines, which prevent long-term damage to the heart.

People with severe shortness of breath from COPD and heart failure may receive other treatments as well:

Corticosteroids, such as prednisone or Solu-Medrol, which can improve breathing in COPD. Antibiotics, for any bacterial infection that may be contributing. Supplemental oxygen. Non-invasive positive pressure ventilation, a form of machine-assisted breathing. Mechanical ventilation, or temporary life support through a breathing tube. Intravenous medicines to help reduce heart strain.

People with both COPD and heart failure are often treated by a team of doctors including a primary care physician, a cardiologist, and a pulmonologist.