British Lung Foundation
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COPD and diastolic heart failure is there a connection

I have just been diagnosed with COPD having suffered with shortness of breath and swelling of my lower legs, last year I was told I had Diastolic Heart Failure so am in a mess and wonder if there is a connection with all this and if so did one thing cause the other for example could my heart problem have been caused by the COPD. I am just so confused. I have been given an inhaler for the breathing and that is it. I would like to know more and how to get help and to help myself and what happens next.


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Purpose of review: Chronic obstructive pulmonary disease (COPD) and heart failure are prevalent comorbidities affecting a huge proportion of the world population, responsible for significant morbidity and mortality. Their coexistence is more frequent than previously recognized and poses important diagnostic and therapeutic challenges. Prognosis of patients with concurrent heart failure and COPD has not been comprehensively addressed. With this review, we intend to emphasize the diagnosis and prognosis implications of the two coexisting conditions and to highlight the therapeutic constraints posed by the combination.

Recent findings: Progressively, more attention has been given to the interplay between COPD and heart failure. The combination is frequent, but largely unrecognized due to overlapping clinical manifestations. Patients presenting with both conditions seem to have an ominous course. Despite the overwhelming evidence supporting cardioselective β-blockade safety and tolerability in COPD patients, β-blockers are underprescribed to heart failure patients with concomitant COPD.

Summary: COPD and heart failure coexistence is often overlooked. COPD diagnosis can remain unsuspected in heart failure patients due to similar symptoms. Although β-blockers are well tolerated in COPD patients, they are overall less prescribed in this challenging population. COPD, at least at severe degrees of airflow obstruction, predicts a worse prognosis in heart failure patients.


Heart failure and chronic obstructive pulmonary disease (COPD) are major public health epidemics, with increasing prevalence.[1,2••,3••] Although both conditions have been extensively studied separately, clinicians often fail to recognize one syndrome in the presence of the other, mainly due to the similarities in clinical presentation and additionally due to scarcity of reports specifically addressing the combination.[4] According to available evidence, COPD and heart failure often coexist, and the prevalence of the combination is variable, depending on the population studied (community, outpatient or hospitalized) and on the diagnostic criteria applied.[4,5••] The coexistence of the two conditions is further supported by shared risk factors, notably age and smoking.[1,5••,6]

Since the publication of several trials demonstrating the efficacy and the survival benefits of β-blockers, these agents are considered the cornerstone of systolic heart failure management.[7–9] Although extensive evidence concerning safety of selective β-1 blockade in respiratory disease has accumulated,[10,11] COPD is commonly advocated as the principal cause for nonadherence to heart failure therapeutic guidelines because it is generally perceived as a contraindication to β-blockers use.[12,13] Indeed, patients with coexisting heart failure and COPD are often deprived of the long-term benefits of this intervention.[12,14] Apart from these therapeutic issues, the prognosis of patients with concomitant heart failure and COPD is not completely understood. In an increasing number of studies,[15•,16•,17] COPD has been found to adversely impact on prognosis of heart failure patients, being an independent predictor of mortality and hospitalization.

The present review focuses on the therapeutic dilemmas and prognostic impact of coexisting COPD and heart failure and outlines the diagnostic challenges presented by the combination. The prevalence of the two coexisting syndromes will be addressed briefly.


hope this helps a little bit,xxx

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Hi trownail. They seem to be connected.

I was diagnosed with COPD and a friend had heart problems but we had exactly the same symptoms. Didn't make any sense to me. Then about 3 years later, during a pulmonary rehab session, I discovered I also had major heart problems. I was one of the few that p.r. did the opposite of its intended purpose!!

Apparently it's the heart that will get me although I'm on more medication for COPD than heart!

Make sure you get looked after for both conditions - good luck and don't be fobbed off.



Hi trownail...when I attended a local hospice last year ( heart and lung patients) we were told that copd could bring about heart failure but not the other way round....Lovelight


I have right sided heart failure, not sure if that's the same as yours, caused by COPD. I was told this definitely. I have just been given an BI-pap machine for night times because the drop in O2 at night exacerbates the problems. I take alot of heart meds (7 different ones) and 2 inhalers.


COPD puts a strain on the heart, and can cause a problem with the heart as noted above.

I have swollen legs, but every time I show it to a consultant (chest one or haematology one) they both say: Mm! Tell your GP. I did, but she didn't do anything about it. I went to buy compression socks on my own volition. the swelling has gone down.

When i was ill in hospital, I didn't have compression socks and the swelling tended to come back. The heart consultant, who was replacing the chest consultant for a couple of days, felt my legs and said that it was "outside his competence"! (For a heart consultant to say this is shockingly amazing!) I had an EEG which showed I had o failure.

When I came out, I put my compression socks back on with difficulty. within a day, the swelling went down.

My answer would be to check with the BLF helpline (03000 030 555 - from 10 am till 1 pm weekdays) and ask where to go with this. Hope you get help soon.


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