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COPD and Heart Failure

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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.

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.

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