2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines | Circulation
What's The Link Between COPD And Heart Failure?
Chronic obstructive pulmonary disease (COPD) and heart failure are different conditions. But both can make you short of breath when you do something physical, like exercise, climbing stairs, or walking for a long distance.
Breathing problems happen for different reasons with these conditions.
With COPD, it's hard to exhale all of the air in your lungs because of lung damage, often from years of smoking.
If you have COPD, you most likely breathe comfortably when you're at rest. But when you're active, your breath starts coming in before air from your last exhale goes out. That causes shortness of breath.
If you have heart failure, your heart doesn't pump blood efficiently. As with COPD, if you have heart failure, you can probably breathe easily when at rest. With activity, blood flow must increase, and your heart must pump harder and faster. If your heart can't keep up, blood "backs up" into the heart and veins, dumping blood into the heart. This causes fluid buildup in the lungs. The increased fluid can lead to shortness of breath.
Left-sided heart failure is most often caused by high blood pressure or coronary artery disease. It's not directly related to COPD. But the two conditions may influence each other.
For example, low oxygen in the blood from COPD may put extra strain on your heart, which worsens left-sided heart failure. And too much fluid in your lungs from heart failure can make breathing even harder if you have COPD.
Severe COPD can cause heart failure in your heart's lower right chamber, or ventricle. This is a condition called right-sided heart failure or cor pulmonale.
Right-sided heart failure causes fluid to build up in your body, such as in your legs and belly area. Many conditions other than COPD also cause right-sided heart failure. Learn more about right-sided heart failure causes and symptoms.
If you have both COPD and heart failure and find yourself short of breath, it can be hard to tell which condition is causing your breathing problems.
Your doctor may give you:
Physical examination: Listening to your lungs and heart, and looking at the veins in your neck, can help your doctor tell the difference between COPD and heart failure.
Chest X-ray: Heart failure may cause fluid in your lungs to be visible on a chest X-ray. With COPD, your lungs are usually clear or may look like they're over-inflated. Find out what happens during a chest X-ray.
Brain natriuretic peptide (BNP) test: This hormone is usually at high levels in your blood if you have heart failure, whether or not you also have COPD.
Pulmonary function tests: Doctors can use breathing tests to diagnose COPD. Get more information on the different types of lung function tests.
Echocardiogram: An ultrasound test of your heart that can evaluate the heart chambers, valves, and pumping strength. Watch a video to see how an echocardiogram works.
Cardiac enzymes: This blood test can help diagnose a heart attack or too much strain on your heart. Read more on how heart disease is diagnosed.
Every case is different. 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 breathing symptoms.
If COPD and heart failure are equally severe, doctors must make their best guess as to which condition is causing your symptoms.
To make things even more complicated, COPD and heart failure can at times act up at the same time. For example, if you have worsening heart failure symptoms that cause rapid breathing, this can make COPD symptoms worse, as well.
If your doctor can't tell which condition causes your shortness of breath, they'll probably treat both together.
Treatments for COPD focus on your lungs and your airways, the branching network of tubes inside the lungs. The main treatments for COPD are bronchodilators, which are inhaled medicines that help open the airways.
Heart failure treatments curb the workload on your heart and help prevent unhealthy growth of heart muscle. Several types of medicines do this.
If you have severe shortness of breath from COPD and heart failure, you may get other treatments, as well:
And, if you have either condition and smoke, quitting should be a top priority for your health.
If you have both COPD and heart failure, a team of doctors will probably treat you, including a primary care physician, a cardiologist, and a pulmonologist, who is a doctor specializing in lung conditions.
COPD Vs. CHF: Similarities And Differences - Healthline
COPD is a term for several types of serious respiratory conditions that block airflow to the lungs. The two main COPD conditions are chronic bronchitis and emphysema. These diseases leave your lungs unable to work at full strength, making it difficult to breathe.
With bronchitis, the airways that extend from your trachea into your lungs become irritated.
Emphysema occurs when serious damage is done to the tiny air sacs in your lungs where oxygen and carbon dioxide are exchanged.
CHF occurs when your heart becomes too weak to pump blood through your body. When blood isn't pumped out of the heart effectively, fluid levels build up or become congested.
When blood backs up or pools in the heart, the heart beats more rapidly and expands to handle the greater volume of blood. This makes heart failure worse.
Shortness of breath and wheezing are symptoms of both COPD and CHF. Breathing difficulties are usually experienced after physical activity and tend to develop gradually.
At first, you may notice feeling out of breath after simple activities such as climbing a set of stairs. As COPD and CHF worsen, shortness of breath or wheezing may occur with little physical effort.
A chronic cough is one of the main symptoms of COPD. The cough can sometimes bring up mucus from your diseased airways. It can also be a dry cough.
People with CHF also tend to have a dry cough that produces sputum. Sputum is mucus that may also contain blood, pus, or bacteria.
COPD can also cause tightness in the chest. CHF doesn't lead to chest tightness, but you may feel your heart beating irregularly or rapidly in your chest.
While they share some common symptoms, COPD and CHF develop from different causes.
The single most common cause of COPD is smoking. A history of smoking doesn't guarantee you'll get COPD, but it increases the likelihood of developing respiratory problems. Smoking is also a risk factor for heart disease and CHF.
Some cases of COPD may be linked to breathing secondhand smoke or inhaling chemicals in the workplace. A family history of COPD can also increase your likelihood of developing the condition.
Heart failure can be caused by coronary artery disease (CAD). This disease occurs when the blood vessels in the heart become blocked, which can cause heart attacks.
Other causes of heart failure include diseases of the heart valves, high blood pressure, and diseases of the heart muscle.
There's no cure for either COPD or CHF, so treatment aims to slow the progression of the diseases and manage symptoms.
Because smoking can contribute to COPD and CHF, quitting smoking will improve your health, regardless of your condition.
Regular physical activity is important to strengthen your heart and lungs, but both COPD and CHF can limit what types of exercises you can do. Talk with your doctor about activities that are safe, and what precautions you should take before and during exercise.
Different medications are used to treat COPD and CHF.
COPD
A common COPD medication is a bronchodilator. This medication relaxes the muscles around your airways, making breathing easier.
Short-acting bronchodilators can last up to six hours and are usually recommended for times when you're more active. Long-lasting bronchodilators can last up to 12 hours and are used every day.
The severity of your COPD will determine what type of bronchodilator is best for you.
If you have severe COPD, you may also need inhaled glucocorticosteroids. These are steroids that help minimize inflammation in your airways.
CHF
CHF can involve the use of several medications. Vasodilators help your heart by widening blood vessels and lowering blood pressure. This helps reduce the burden on your heart. Beta blockers can lower the heart rate and reduce the burden on the heart.
Other key medications include diuretics, which reduce the amount of fluid and sodium in your body. They can also help lower blood pressure.
A drug called digoxin strengthens heart contractions. It can be an important part of CHF treatment if other medications are not helpful, or if you have an abnormal heart rhythm like atrial fibrillation.
Anticoagulant medications may also be used to treat CHF. These medications can help reduce the risk of blood clots. For cases of severe CHF and COPD, oxygen therapy is often used. This therapy delivers oxygen to the lungs through a tube in the nose.
The main preventive measure to avoid COPD is to never smoke, or to stop smoking. Many products and therapies can help people quit smoking. Ask your doctor about these methods or look for programs in your community or at your local hospital.
Not smoking can also help preserve heart health. Other steps to help lower your risk of CHF include:
Having regular checkups and following your doctor's advice may also help prevent COPD, CHF, and other serious health problems.
COPD and CHF are serious conditions that affect your breathing and can affect your activity in life. Although both have similar symptoms and risk factors, COPD affects your lungs and CHF affects your heart.
Different medications are used to treat each condition. However, eating healthy, getting plenty of exercise, and quitting smoking are good treatments for both.
Finerenone Improves Clinical Outcomes In HF Regardless Of COPD Status
Finerenone mitigates clinical events and symptoms regardless of chronic obstructive pulmonary disease (COPD) status in heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), according to study findings published in the European Journal of Heart Failure.
Investigators compared finerenone with placebo to determine the efficacy and safety for treatment of HF, stratified by COPD status.
The investigators conducted a prespecified analysis of the FINEARTS-HF trial (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients with Heart Failure; ClinicalTrials.Gov Identifier: NCT04435626). Briefly, FINEARTS was a double-blind, randomized, placebo-controlled trial exploring the efficacy and safety of finerenone vs placebo in symptomatic HFmrEF and HFpEF. In the current study, the composite of cardiovascular death and total worsening HF events was the primary outcome.
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In patients with HFmrEF/HFpEF, the beneficial effects of finerenone on clinical events and symptoms were consistent, regardless of COPD status.
Among the 6001 patients aged at least 40 years with HF randomly assigned 1:1 to finerenone or placebo in FINEARTS-HF, 12.9% (n=773) had an investigator-reported history of COPD. Patients with COPD vs those without had more prior HF hospitalization, obesity, peripheral artery disease, atrial fibrillation, and hypertension, as well as elevated high-sensitivity troponin T levels. They also had more adverse New York Heart Association (NYHA) class and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores.
Patients with COPD were more likely to be older White men who smoked with a lower health-related quality of life. Patients with estimated glomerular filtration rate (eGFR) of less than 25 mL/min/1.73 m2 or serum potassium of greater than 5.0 mmol/L at screening or randomization were among those excluded, as were patients with severe pulmonary disease requiring home oxygen or chronic oral steroid therapy. Patients with COPD vs without were more frequently treated with a loop diuretic, and less frequently treated with a beta-blocker.
Higher risk for the primary endpoint was found among patients with COPD (adjusted rate ratio [aRR], 1.44; 95% CI, 1.21-1.71). Regardless of COPD status, finerenone benefits for the primary outcome were consistent (aRR with COPD, 0.84 [95% CI, 0.61-1.16]; aRR with no COPD, 0.84 [95% CI, 0.73-0.97]; Pinteraction =.93). All secondary outcomes presented consistent effects.
KCCQ total symptom score from baseline to 12 months was improved with finerenone to similar extent in patients with or without COPD (Pinteraction =.46). Finerenone nominally appeared to improve NYHA class in patients with COPD, although not in those without COPD, from baseline to 12 months (Pinteraction =.048).
Study limitations include lack of generalizability to all individuals with HFmrEF or HFpEF, possible misclassification of COPD status, and lack of data on exacerbation history, COPD staging, frequency of rescue inhaler use, and right ventricular function.
The investigators confirmed history of COPD was common in HFmrEF and HFpEF, associated with worse clinical outcomes and health status, and they concluded,
"In patients with HFmrEF/HFpEF, the beneficial effects of finerenone on clinical events and symptoms were consistent, regardless of COPD status."
Disclosure: This research was supported by Bayer AG. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors' disclosures.
This article originally appeared on The Cardiology Advisor
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