Are My Symptoms From COPD, Heart Failure, or Both?

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Chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are two conditions that can cause dyspnea (shortness of breath), exercise intolerance, and fatigue. They both also progress over time and tend to affect smokers over the age of 60. While there are ways to differentiate the two to determine whether you have COPD or CHF, they can also co-exist—a situation that cannot be overlooked, as it worsens overall well-being and complicates treatment.

Comparing Symptoms

Common Disease Effects
Symptoms COPD CHF
Dyspnea (shortness of breath) Yes Yes
Fatigue Yes Yes
Cough Yes No
Palpitations (feeling of irregular heartbeat) No Yes
Frequent respiratory infections Yes No
Sleep apnea Yes No
Chest pain No Yes
Weakness Yes Yes
Dizziness Late stage Yes
Frequent urination at night No Yes
Loss of appetite No Yes
Trouble concentrating, confusion  Late stage Late stage

Shortness of breath and fatigue are the most prominent effects of CHF and COPD. For both conditions, shortness of breath typically occurs with physical exertion in the early disease stages, and it can occur at rest with advanced disease.

Many of the other effects—even those that occur with both conditions—occur at different disease stages with each disease or have different characteristics with CHF than they do with COPD.  For example, COPD is characterized by a persistent cough and wheezing, while CHF is more likely to be associated with chest pain and leg swelling.

Orthopnea is dyspnea that is worse when lying flat. This is a common characteristic of CHF and it occurs in very advanced stages of COPD.

Exacerbations

Both conditions can involve exacerbations, which are episodes characterized by worsening symptoms.

  • In general COPD exacerbations worsen rapidly, with severe shortness of breath and a feeling of suffocation. COPD exacerbations may be triggered by infections, smoke, and fumes.
  • Typically, CHF exacerbations are slower in their progression and can be triggered by changes in diet (such as consuming excess salt).

For both conditions, exacerbations can occur when you don't take your medication as directed. Of greater concern, CHF and COPD exacerbations can each happen without an obvious trigger. Both types of exacerbations can be life-threatening and require medical attention.

If you have already been diagnosed with CHF or COPD, you might not notice early signs of the other disease due to the similarities in symptoms. If you experience changes in your symptoms, be sure to tell your doctor because you could be developing another condition in addition to the one you have already been diagnosed with.

Causes

Sometimes COPD and CHF occur together. They can also develop independently due to their overlapping risk factors, such as smoking, sedentary lifestyle, and obesity.

Despite this, specific physical damage that leads to each illness is different. Lung damage causes COPD, and heart damage causes CHF. The damage occurs slowly and gradually in both conditions, and it is irreversible.

Risk Factors COPD CHF
Smoking Yes Yes
Hypertension  No Yes
Heart disease No Yes
Genetics  Yes No
Secondhand smoke Yes No
High fat and cholesterol levels No Yes
Recurrent lung infections Yes No
Obesity Yes Yes
Sedentary lifestyle  Yes Yes

How COPD Develops

Severe lung inflammation and injury cause COPD. This occurs due to smoking, secondhand smoke, airborne toxin exposure, and/or recurrent lung infections. Over time, repeated lung injury results in thickened, narrow airways that make it hard to breathe.

Damaged lungs and thickened airways also produce pressure on the blood vessels in the lungs, resulting in pulmonary hypertension.

When the lungs are severely damaged in COPD, the pressure in the arteries of the lungs becomes very high, causing a back up of pressure on the right side of the heart as it sends blood to the lungs. This eventually leads to cor pulmonale—a type of right heart failure caused by lung disease.

How CHF Develops

Typically, CHF occurs due to heart disease. A weakened heart muscle, heart valve disease, or chronic hypertension (high blood pressure) are the frequent causes of CHF.

The most common cause of heart muscle weakness is damage due to myocardial infarction (MI, or heart attack). An MI is a life-threatening event that occurs when an artery that supplies blood to one or more of the heart muscles becomes blocked. The resulting heart muscle damage and diminished heart-pumping ability are described as heart failure.

High blood pressure, elevated fat and cholesterol, and smoking lead to damage and blockage of the arteries that supply the heart muscles.

Diagnosis

The diagnosis of COPD and CHF are both based on clinical history, physical exam, and specific diagnostic tests. The physical examination findings and test results differ in the early stages of these conditions, but start to show some similarities in the late stages.

Fatigue is consistently present in both conditions. With CHF, your dyspnea can be constant and stable. Dyspnea is more likely to fluctuate with COPD. These slight differences will be noted by your physician.

Physical Exam

When you go to see your doctor, they will take your vitals (temperature, heart rate, respiratory rate, and blood pressure), listen to your heart and lungs, and examine your extremities.

Physical Exam Finding COPD CHF
Wheezing Yes No
Crackling lung sounds No Yes
Heart murmur No Yes
Edema  Late stage Yes
Enlarged neck veins Late stage Yes
Cyanosis (pale or bluish fingers, toes, lips) Yes No
Tachypnea (rapid breathing) Yes No
Tachycardia (rapid heart rate) Yes No
Bradycardia (slow heart rate) No Yes
Hypertension No Yes

Pulmonary Function Tests

Pulmonary function tests (PFTs) require your cooperation as you follow instructions to inhale and exhale into a mouthpiece. Tests that measure your lung function will show characteristic changes in COPD, and they can show impaired pulmonary function in CHF as well. However, there are some key differences.

With COPD, pulmonary function can improve substantially after treatment with a bronchodilator. While there can be some improvement in pulmonary function measurements after bronchodilator treatment in CHF, these improvements are minor.

Imaging

Tests like chest X-ray, computerized tomography (CT), or magnetic resonance imaging (MRI) can show signs of CHF or COPD.

Often, the heart looks enlarged when a person has CHF. With CHF exacerbation, fluid builds up in or around the lungs, and this can be seen on chest imaging studies.

Imaging tests can show lung changes consistent with COPD, including thickening, inflammation, and bullae (air-filled spaces in the lungs that compress healthy tissue).

Echocardiogram

An echocardiogram (echo) is an ultrasound that examines the heart as it is pumping. With an echo, your doctor can observe the structure of your heart, blood flow in coronary (heart) arteries, and the pumping function of the heart muscle itself.

If heart function is reduced (often described as a low ejection fraction), this could suggest CHF. An echo is not part of the diagnosis of COPD.

Treatment

The most important strategy when it comes to managing CHF and/or COPD is to stop smoking. Additionally, both of these conditions require maintenance treatment as well as treatment for exacerbations.

Anti-inflammatory medications and bronchodilators (such as beta-agonists) are used for managing COPD.

Medications that promote heart muscle activity (such as beta-blockers), diuretics that release of excess fluid, and prescriptions to control blood pressure are used in the long-term management of CHF. 

Exacerbations

Exacerbations and late-stage cases of COPD and CHF may involve oxygen therapy. Sometimes, COPD exacerbations also may be associated with lung infections that require antibiotic treatment.

And a severe COPD exacerbation may impair breathing to such a degree that mechanical ventilation becomes necessary; this need for respiratory support is not as common in CHF exacerbations.

Modified Treatment for Combined COPD and CHF

Some medications used for COPD can exacerbate CHF. In COPD, beta-agonists dilate the airways, but they can also impair heart function. In fact, beta-blockers, which actually oppose the action of beta-agonists, are typically used in CHF.

Experts suggest the use of cardioselective beta-blockers for the treatment of CHF in people who also have COPD because these medications specifically target the heart without interfering with lung function.

Lifestyle Strategies

In addition to smoking cessation, other lifestyle strategies can help prevent the progression of COPD and CHF. Regular exercise improves your heart and lung function.

If you want some direction and guidelines, you can ask your doctor for a physical therapy consultation as you get started on an exercise program. Cardiac rehabilitation and/or pulmonary rehabilitation can be beneficial as you work towards gaining endurance and strength.

If you are overweight, weight loss will reduce the excess strain on your heart and lungs. Exercise is likely to help with weight loss as well.

Stress contributes to hypertension, which worsens CHF. Stress also triggers COPD exacerbations, and recurrent exacerbations cause COPD to worsen. As such, stress management plays a role in reducing the progression of both conditions.

A Word From Verywell

If you do have both CHF and COPD, you can experience worsening symptoms due to exacerbation of either condition. Whenever you sense that the effects of your condition (or conditions) are worsening, you should see your doctor. You may need urgent treatment for an exacerbation and/or and adjustment of your maintenance medications.

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