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COPD means you have a higher risk of heart disease. What do you need to know about the types, symptoms, diagnosis, and management?

Chronic obstructive pulmonary disease is serious on its own. Cardiovascular disease is serious on its own. When they strike together in the same patient, the prognosis is worse. This concerning combination is, unfortunately, not uncommon — things like being older, leading a sedentary life, inflammation, and metabolic disorders increase your risk of both COPD and heart disease. 

Then, there's smoking. The leading cause of COPD in developed nations, this nasty habit doesn't just damage the lungs. It also puts a strain on your heart, so it's no surprise that smokers have a higher risk of ending up with cardiovascular disease, too — and to die from it. 

Because you can only access the best possible treatment if you have the correct diagnosis, COPD patients should routinely be evaluated for heart disease. The most common heart diseases seen in people with COPD are:

  • Heart failure
  • Coronary artery disease
  • Atrial fibrillation.
These heart diseases cause the deaths of around a quarter of COPD patients, so being familiar with them is rathere important if you have been diagnosed with chronic obstructive pulmonary disease. What do you need to know?

COPD and coronary artery disease

Coronary artery disease is an umbrella term for conditions that affect the coronary arteries, the vessels that supply your heart. Stable angina, unstable angina, myocardial infarction (heart attack), and sudden cardiac death all fall into this category. The risk of developing coronary artery disease is very real for COPD patients; more than half of those waiting for a lung transplant have one of the conditions that fall under CAD. 

Making diagnosis tricker is the fact that some of the warning signs that can point to coronary artery disease are also common COPD symptoms:

  • Shortness of breath
  • Feeling physically unable to exercise
  • Severe fatigue
COPD patients who notice chest pain in addition to their usual symptoms should, however, promptly inform their doctor. That is because this one symptom sets CAD apart from CAD. 

If you're ultimately diagnosed with coronary heart disease, here are some things you need to know:

  • People who have comorbid COPD and coronary artery disease are more likely to die from heart-related causes. They're more likely to end up with heart failure, too. 
  • However, treatment plans are available for CAD, and your heart disease will be managed the same way it wwould be if you didn't also have COPD. Antiplatelet therapy, statins, inhibitors of the renin-angiotensin-aldosterone system, and β-adrenergic blockers can all help you. 
  • COPD treatment can also continue as before, and your long-acting inhalers (bronchodilators) can even be good for your arteries and heart function, as well. 

COPD and atrial fibrillation

Atrial fibrillation is the most prevalent kind of irregular heartbeat (arrhythmia), both in COPD sufferers and others. This condition increases your risk of stroke, heart failure, and blood clots, as well as other cardiovascular problems. If you are a COPD patient and have hypoxia (an oxygen deficiency), inflammation, or still smoke, these factors all increase your risk of atrial fibrillation. Having atrial fibrillation increases the risk of death in people with COPD who need to be hospitalized. 

Here's what else you need to know:

  • While atrial fibrillation may not have any symptoms, both COPD and atrial fibrillation can lead to shortness of breath and fatigue. 
  • Atrial fibrillation is, however, diagnosed through ECG. 
  • Having both COPD and atrial fibrillation will not affect the way either of these conditions is treated. Again, your bronchodilators may benefit your heart rhythm as well. 

COPD and heart failure

Heart failure is among the most dangerous potential consequences of COPD. Unfortunately, it isn't rare — nearly a third of COPD sufferers are thought to have congestive heart failure. This can ultimately be blamed on the fact that heart and lung function are very much linked. If your oxygen levels aren't sufficient, your heart will suffer. 

There's good news too, right? Yes. A timely COPD diagnosis followed by proper treatment reduces your risk of heart failure. 

Once again, the symptoms of heart failure mimic many of the usual ones COPD patients already live with, like: 

  • Shortness of breath, particularly after exerting yourself physically
  • Being unable to tolerate exercise
  • Fatigue
Look out for swelling of your legs, however. This symptom isn't typically seen in COPD, but often strikes in people with heart failure. 

Left-sided heart failure is typically linked to coronary artery disease or hypertension, while right-sided heart failure (cor pulmonale) can directly result from severe chronic obstructive pulmonary disease. You won't be able to tell which side of your heart is giving you trouble, but your doctor can. When diagnosing heart failure, you can expect these tests:

  • A physical exam during which your doctor will look for distended veins and swelling, among other things. 
  • A lung X-ray or CT to differentiate between heart failure and COPD
  • An echocardiogram (heart ultrasound) to determine how your heart is functioning.
  • Blood tests to check your basic natriuretic peptides, which will be high in patients with heart failure.

If you are diagnosed with heart failure in addition to pre-existing COPD, you can expect to work with a team of medical specialists. Your treatment protocol for heart failure doesn't need to be different for COPD patients than for those who don't have co-existing conditions, but "COPD + heart failure" patients do seem to tolerate the medication bisoprolol better than some other meds. Managing COPD may be slightly different in patients diagnosed with heart failure, with LAMAs being better than β2-agonists. As always, should you still smoke, quitting should be your number one priority if you suffer from both of these conditions at the same time. 

  • Roversi, S., Fabbri, L. M., Sin, D. D., Hawkins, N. M., & Agustí, A. (2016). Chronic Obstructive Pulmonary Disease and Cardiac Diseases. An Urgent Need for Integrated Care. American Journal of Respiratory and Critical Care Medicine, 194(11), 1319–1336.
  • Čelutkienė, J., Balčiūnas, M., Kablučko, D., Vaitkevičiūte, L., Vaitkevičiūte, J. B., … Danila, E. (2017). Challenges of Treating Acute Heart Failure in Patients with Chronic Obstructive Pulmonary Disease. Cardiac Failure Review, 03(01), 56.
  • Rabe, K. F., Hurst, J. R., & Suissa, S. (2018). Cardiovascular disease and COPD: dangerous liaisons? European Respiratory Review, 27(149), 180057.
  • Photo courtesy of SteadyHealth

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