From the Guidelines
Chronic heart failure and chronic COPD have a profound impact on each other's organ systems, leading to significant morbidity and mortality, and thus, require careful management to improve quality of life. The effects of chronic heart failure on the lungs are multifaceted, including pulmonary edema, pleural effusions, and pulmonary hypertension, which can lead to right heart failure over time 1. Patients with heart failure experience shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and decreased exercise tolerance. Conversely, chronic COPD affects the heart by causing pulmonary hypertension due to hypoxic vasoconstriction and destruction of pulmonary vessels, leading to right ventricular hypertrophy and eventually right heart failure (cor pulmonale) 1. Some key points to consider in the management of these co-existing conditions include:
- The prevalence of COPD in heart failure patients ranges between 20 and 30%, and COPD is a strong and independent risk factor for cardiovascular morbidity and mortality 1
- Diagnostic assessment of heart failure in the presence of COPD is challenging due to overlapping signs and symptoms, and evaluation of natriuretic peptide levels may be helpful in this population 1
- Agents with documented effects on morbidity and mortality, such as ACEIs, β-blockers, and ARBs, are recommended in patients with co-existing pulmonary disease, and supervised rehabilitation programs may be appropriate to improve skeletal muscle function and fatigue 1
- The majority of patients with heart failure and COPD can safely tolerate β-blocker therapy, but initiation at a low dose and gradual up-titration is recommended 1. Overall, the management of chronic heart failure and COPD requires a comprehensive approach that takes into account the complex interactions between these two conditions and their impact on quality of life.
From the Research
Effects of Chronic Heart Failure on the Lungs
- Chronic heart failure (CHF) can lead to lung function abnormalities, including restrictive respiratory patterns and impaired gas exchange capacity 2, 3, 4.
- Severe heart failure patients often show a restrictive respiratory pattern, secondary to heart enlargement and increased lung fluids, and impairment of alveolar-capillary gas diffusion 2.
- CHF can cause airway obstruction, impaired gas diffusing capacity, and pulmonary hypertension in the longer term 3.
- The reduction in diffusing capacity in patients with chronic left HF is not primarily attributable to increases in lung water but is improved by any sustained treatment that improves overall cardiac function 4.
Effects of Chronic COPD on the Heart
- Chronic obstructive pulmonary disease (COPD) patients are at an increased risk of mortality from cardiovascular events 5.
- COPD can exacerbate heart failure, and the coexistence of COPD and CHF presents clinicians with diagnostic and therapeutic challenges 5, 6.
- The bidirectional relationship between heart failure and lung dysfunction is well-established, with declining lung function serving as a predictor for heart failure progression and severity 6.
- Pressure overload, chronic systemic inflammation, and changes in the extracellular matrix (ECM) are the main mechanisms linking COPD and heart dysfunction 6.