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European Journal of Heart Failure 2009 11(2):130-139; doi:10.1093/eurjhf/hfn013
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology

Nathaniel Mark Hawkins1,*, Mark C. Petrie2, Pardeep S. Jhund3, George W. Chalmers2, Francis G. Dunn4 and John J.V. McMurray3

1 Aintree Cardiac Centre, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK
2 Royal Infirmary, Glasgow, UK
3 Western Infirmary, Glasgow, UK
4 Stobhill Hospital, Glasgow, UK

* Corresponding author. Tel: +44 151 529 2717, Fax: +44 151 529 2724, Email: nathawkins{at}hotmail.com


  Abstract

Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are global epidemics incurring significant morbidity and mortality. The combination presents many diagnostic challenges. Clinical symptoms and signs frequently overlap. Evaluation of cardiac and pulmonary function is often problematic and occasionally misleading. Echocardiography and pulmonary function tests should be performed in every patient. Careful interpretation is required to avoid misdiagnosis and inappropriate treatment. Airflow obstruction, in particular, must be demonstrated when clinically euvolaemic. Very high and very low concentrations of natriuretic peptides have high positive and negative predictive values for diagnosing HF in those with both conditions. Intermediate values are less informative. Both conditions are systemic disorders with overlapping pathophysiological processes. In patients with HF, COPD is consistently an independent predictor of death and hospitalization. However, the impact on ischaemic and arrhythmic events is unknown. Greater collaboration is required between cardiologists and pulmonologists to better identify and manage concurrent HF and COPD. The resulting symptomatic and prognostic benefits outweigh those attainable by treating either condition alone.

Key Words: Heart failure • Chronic obstructive pulmonary disease

Received January 24, 2008; Revised August 31, 2008; Accepted November 3, 2008


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