Comparing Symptoms
Many of the other effects—even those that occur with both conditions—occur at different disease stages with each disease or have different characteristics with CHF than they do with COPD. For example, COPD is characterized by a persistent cough and wheezing, while CHF is more likely to be associated with chest pain and leg swelling.
Orthopnea is dyspnea that is worse when lying flat. This is a common characteristic of CHF and it occurs in very advanced stages of COPD.
Exacerbations
Both conditions can involve exacerbations, which are episodes characterized by worsening symptoms.
In general, COPD exacerbations worsen rapidly, with severe shortness of breath and a feeling of suffocation. COPD exacerbations may be triggered by infections, smoke, and fumes. Typically, CHF exacerbations are slower in their progression and can be triggered by changes in diet (such as consuming excess salt).
For both conditions, exacerbations can occur when you don’t take your medication as directed. Of greater concern, CHF and COPD exacerbations can each happen without an obvious trigger. Both types of exacerbations can be life-threatening and require medical attention.
Causes
Sometimes COPD and CHF occur together. They can also develop independently due to their overlapping risk factors, such as smoking, sedentary lifestyle, and obesity.
Despite this, specific physical damage that leads to each illness is different. Lung damage causes COPD, and heart damage causes CHF. The damage occurs slowly and gradually in both conditions, and it is irreversible.
Damaged lungs and thickened airways also produce pressure on the blood vessels in the lungs, resulting in pulmonary hypertension.
How CHF Develops
Typically, CHF occurs due to heart disease. A weakened heart muscle, heart valve disease, or chronic hypertension (high blood pressure) are the frequent causes of CHF.
The most common cause of heart muscle weakness is damage due to myocardial infarction (MI, or heart attack). An MI is a life-threatening event that occurs when an artery that supplies blood to one or more of the heart muscles becomes blocked. The resulting heart muscle damage and diminished heart-pumping ability are described as heart failure.
High blood pressure, elevated fat and cholesterol, and smoking lead to damage and blockage of the arteries that supply the heart muscles.
Diagnosis
The diagnosis of COPD and CHF are both based on clinical history, physical exam, and specific diagnostic tests. The physical examination findings and test results differ in the early stages of these conditions, but start to show some similarities in the late stages.
Fatigue is consistently present in both conditions. With CHF, your dyspnea can be constant and stable. Dyspnea is more likely to fluctuate with COPD. These slight differences will be noted by your healthcare provider.
Physical Exam
When you go to see your healthcare provider, they will take your vitals (temperature, heart rate, respiratory rate, and blood pressure), listen to your heart and lungs, and examine your extremities.
With COPD, pulmonary function may or may not improve after treatment with a bronchodilator. While there can be some improvement in pulmonary function measurements after bronchodilator treatment in CHF, these improvements are minor.
Imaging
Tests like chest X-ray, computerized tomography (CT), or magnetic resonance imaging (MRI) can show signs of CHF or COPD.
Often, the heart looks enlarged when a person has CHF. With CHF exacerbation, fluid builds up in or around the lungs, and this can be seen on chest imaging studies.
Imaging tests can show lung changes consistent with COPD, including thickening, inflammation, and bullae (air-filled spaces in the lungs that compress healthy tissue).
Echocardiogram
An echocardiogram (echo) is an ultrasound that examines the heart as it is pumping. With an echo, your healthcare provider can observe the structure of your heart, blood flow in coronary (heart) arteries, and the pumping function of the heart muscle itself.
If heart function is reduced (often described as a low ejection fraction), this could suggest CHF. An echo is not part of the diagnosis of COPD.
Treatment
The most important strategy when it comes to managing CHF and/or COPD is to stop smoking. Additionally, both of these conditions require maintenance treatment as well as treatment for exacerbations.
Anti-inflammatory medications and bronchodilators (such as beta-agonists) are used for managing COPD.
Medications that promote heart muscle activity (such as beta-blockers), diuretics that release of excess fluid, and prescriptions to control blood pressure are used in the long-term management of CHF.
Exacerbations
Exacerbations and late-stage cases of COPD and CHF may involve oxygen therapy. Sometimes, COPD exacerbations also may be associated with lung infections that require antibiotic treatment.
And a severe COPD exacerbation may impair breathing to such a degree that mechanical ventilation becomes necessary; this need for respiratory support is not as common in CHF exacerbations.
Modified Treatment for Combined COPD and CHF
Some medications used for COPD can exacerbate CHF. In COPD, beta-agonists dilate the airways, but they can also impair heart function. In fact, beta-blockers, which actually oppose the action of beta-agonists, are typically used in CHF.
Experts suggest the use of cardioselective beta-blockers for the treatment of CHF in people who also have COPD because these medications specifically target the heart without interfering with lung function.
Lifestyle Strategies
In addition to smoking cessation, other lifestyle strategies can help prevent the progression of COPD and CHF. Regular exercise improves your heart and lung function.
If you want some direction and guidelines, you can ask your healthcare provider for a physical therapy consultation as you get started on an exercise program. Cardiac rehabilitation and/or pulmonary rehabilitation can be beneficial as you work towards gaining endurance and strength.
If you are overweight, weight loss will reduce the excess strain on your heart and lungs. Exercise is likely to help with weight loss as well.
Stress contributes to hypertension, which worsens CHF. Stress also triggers COPD exacerbations, and recurrent exacerbations cause COPD to worsen. As such, stress management plays a role in reducing the progression of both conditions.
A Word From Verywell
If you do have both CHF and COPD, you can experience worsening symptoms due to exacerbation of either condition. Whenever you sense that the effects of your condition (or conditions) are worsening, you should see your healthcare provider. You may need urgent treatment for an exacerbation and/or and adjustment of your maintenance medications.
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