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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, it’s 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 can’t 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 heart’s 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) change. The blood pressure inside these arteries goes up, as well. This is one type of a condition called pulmonary hypertension.

The heart’s 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.

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