Table of ContentsView AllTable of ContentsComparing SymptomsCausesDiagnosisTreatmentA Word From Verywell
Table of ContentsView All
View All
Table of Contents
Comparing Symptoms
Causes
Diagnosis
Treatment
A Word From Verywell
Chronic obstructive pulmonary disease (COPD)andcongestive heart failure (CHF)are two conditions that can causedyspnea (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.
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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.
Orthopneais dyspnea that is worse when lying flat. This is a common characteristic of CHF and it occurs in very advanced stages of COPD.
Exacerbations
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 healthcare provider because you could be developing another conditionin additionto the one you have already been diagnosed with.
Pulmonary Contusion (Bruised Lung): Causes and Treatments
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.
How COPD Develops
Severe lung inflammation and injurycause 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 inpulmonary hypertension.
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 tomyocardial 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.
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.
Physical Exam
When you go to see your healthcare provider, 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 FindingCOPDCHFWheezingYesNoCrackling lung soundsNoYesHeart murmurNoYesEdemaLate stageYesEnlarged neck veinsLate stageYesCyanosis (pale or bluish fingers, toes, lips)YesNoTachypnea (rapid breathing)YesYesTachycardia (rapid heart rate)YesYesBradycardia (slow heart rate)YesYesHypertensionNoYesPulmonary Function TestsPulmonary 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 may or may not improve after treatment with abronchodilator. While there can be some improvement in pulmonary function measurements after bronchodilator treatment in CHF, these improvements are minor.ImagingTests like chest X-ray,computerized tomography (CT), ormagnetic 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).EchocardiogramAn echocardiogram (echo)is an ultrasound that examines the heart as it is pumping. With an echo, your healthcare provider can observe thestructure 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 lowejection fraction), this could suggest CHF.An echo is not part of the diagnosis of COPD.TreatmentThe 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 formanaging COPD.Medications that promote heart muscle activity (such asbeta-blockers), diuretics that release of excess fluid, and prescriptions to control blood pressure are used in the long-term management of CHF.ExacerbationsExacerbations and late-stage cases of COPD and CHF may involveoxygen 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 CHFSome 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 actuallyopposethe action of beta-agonists, are typically used in CHF.Experts suggest the use ofcardioselective beta-blockersfor the treatment of CHF in people who also have COPD because these medications specifically target the heart without interfering with lung function.Lifestyle StrategiesIn 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 healthcare provider for a physical therapy consultation as you get started on an exercise program.Cardiac rehabilitationand/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.Exercise Tolerance in COPDA Word From VerywellIf 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 healthcare provider. You may need urgent treatment for an exacerbation and/or and adjustment of your maintenance medications.
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 may or may not improve after treatment with abronchodilator. 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), ormagnetic 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 healthcare provider can observe thestructure 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 lowejection fraction), this could suggest CHF.An echo is not part of the diagnosis of COPD.
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 formanaging COPD.
Medications that promote heart muscle activity (such asbeta-blockers), diuretics that release of excess fluid, and prescriptions to control blood pressure are used in the long-term management of CHF.
Exacerbations and late-stage cases of COPD and CHF may involveoxygen 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 actuallyopposethe action of beta-agonists, are typically used in CHF.
Experts suggest the use ofcardioselective beta-blockersfor 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 healthcare provider for a physical therapy consultation as you get started on an exercise program.Cardiac rehabilitationand/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.
Exercise Tolerance in COPD
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 healthcare provider. You may need urgent treatment for an exacerbation and/or and adjustment of your maintenance medications.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Plachi F, Balzan FM, Sanseverino RA, et al.Characteristics associated with mortality in patients with chronic obstructive pulmonary disease (COPD)-heart failure coexistence.Prim Health Care Res Dev. 2018;19(6):570-574.doi:10.1017/S1463423618000117Vitacca M, Paneroni M.Rehabilitation of Patients with Coexisting COPD and Heart Failure.COPD. 2018;15(3):231-237.doi:10.1080/15412555.2018.1468427Hewitt R, Farne H, Ritchie A, Luke E, Johnston SL, Mallia P.The role of viral infections in exacerbations of chronic obstructive pulmonary disease and asthma.Ther Adv Respir Dis. 2016;10(2):158-74. doi:10.1177/1753465815618113Beghé B, Verduri A, Bottazzi B, et al.Echocardiography, spirometry, and systemic acute-phase inflammatory proteins in smokers with COPD or CHF: an observational study.PLoS ONE. 2013;8(11):e80166.doi:10.1371/journal.pone.0080166Wong C, Chen S, Iyngkaran P.Cardiac Imaging in Heart Failure with Comorbidities.Curr Cardiol Rev. 2017;13(1):63-75.doi:10.2174/1573403x12666160803100928Casu G, Merella P.Diuretic Therapy in Heart Failure - Current Approaches.Eur Cardiol. 2015;10(1):42-47. doi:10.15420/ecr.2015.10.01.42Mtisi TF, Frishman WH.Beta Adrenergic Blocker Use in Patients With Chronic Obstructive Pulmonary Disease and Concurrent Chronic Heart Failure With a Low Ejection Fraction.Cardiol Rev.2020;28(1):20-25.doi:10.1097/CRD.0000000000000284
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Plachi F, Balzan FM, Sanseverino RA, et al.Characteristics associated with mortality in patients with chronic obstructive pulmonary disease (COPD)-heart failure coexistence.Prim Health Care Res Dev. 2018;19(6):570-574.doi:10.1017/S1463423618000117Vitacca M, Paneroni M.Rehabilitation of Patients with Coexisting COPD and Heart Failure.COPD. 2018;15(3):231-237.doi:10.1080/15412555.2018.1468427Hewitt R, Farne H, Ritchie A, Luke E, Johnston SL, Mallia P.The role of viral infections in exacerbations of chronic obstructive pulmonary disease and asthma.Ther Adv Respir Dis. 2016;10(2):158-74. doi:10.1177/1753465815618113Beghé B, Verduri A, Bottazzi B, et al.Echocardiography, spirometry, and systemic acute-phase inflammatory proteins in smokers with COPD or CHF: an observational study.PLoS ONE. 2013;8(11):e80166.doi:10.1371/journal.pone.0080166Wong C, Chen S, Iyngkaran P.Cardiac Imaging in Heart Failure with Comorbidities.Curr Cardiol Rev. 2017;13(1):63-75.doi:10.2174/1573403x12666160803100928Casu G, Merella P.Diuretic Therapy in Heart Failure - Current Approaches.Eur Cardiol. 2015;10(1):42-47. doi:10.15420/ecr.2015.10.01.42Mtisi TF, Frishman WH.Beta Adrenergic Blocker Use in Patients With Chronic Obstructive Pulmonary Disease and Concurrent Chronic Heart Failure With a Low Ejection Fraction.Cardiol Rev.2020;28(1):20-25.doi:10.1097/CRD.0000000000000284
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Plachi F, Balzan FM, Sanseverino RA, et al.Characteristics associated with mortality in patients with chronic obstructive pulmonary disease (COPD)-heart failure coexistence.Prim Health Care Res Dev. 2018;19(6):570-574.doi:10.1017/S1463423618000117Vitacca M, Paneroni M.Rehabilitation of Patients with Coexisting COPD and Heart Failure.COPD. 2018;15(3):231-237.doi:10.1080/15412555.2018.1468427Hewitt R, Farne H, Ritchie A, Luke E, Johnston SL, Mallia P.The role of viral infections in exacerbations of chronic obstructive pulmonary disease and asthma.Ther Adv Respir Dis. 2016;10(2):158-74. doi:10.1177/1753465815618113Beghé B, Verduri A, Bottazzi B, et al.Echocardiography, spirometry, and systemic acute-phase inflammatory proteins in smokers with COPD or CHF: an observational study.PLoS ONE. 2013;8(11):e80166.doi:10.1371/journal.pone.0080166Wong C, Chen S, Iyngkaran P.Cardiac Imaging in Heart Failure with Comorbidities.Curr Cardiol Rev. 2017;13(1):63-75.doi:10.2174/1573403x12666160803100928Casu G, Merella P.Diuretic Therapy in Heart Failure - Current Approaches.Eur Cardiol. 2015;10(1):42-47. doi:10.15420/ecr.2015.10.01.42Mtisi TF, Frishman WH.Beta Adrenergic Blocker Use in Patients With Chronic Obstructive Pulmonary Disease and Concurrent Chronic Heart Failure With a Low Ejection Fraction.Cardiol Rev.2020;28(1):20-25.doi:10.1097/CRD.0000000000000284
Plachi F, Balzan FM, Sanseverino RA, et al.Characteristics associated with mortality in patients with chronic obstructive pulmonary disease (COPD)-heart failure coexistence.Prim Health Care Res Dev. 2018;19(6):570-574.doi:10.1017/S1463423618000117
Vitacca M, Paneroni M.Rehabilitation of Patients with Coexisting COPD and Heart Failure.COPD. 2018;15(3):231-237.doi:10.1080/15412555.2018.1468427
Hewitt R, Farne H, Ritchie A, Luke E, Johnston SL, Mallia P.The role of viral infections in exacerbations of chronic obstructive pulmonary disease and asthma.Ther Adv Respir Dis. 2016;10(2):158-74. doi:10.1177/1753465815618113
Beghé B, Verduri A, Bottazzi B, et al.Echocardiography, spirometry, and systemic acute-phase inflammatory proteins in smokers with COPD or CHF: an observational study.PLoS ONE. 2013;8(11):e80166.doi:10.1371/journal.pone.0080166
Wong C, Chen S, Iyngkaran P.Cardiac Imaging in Heart Failure with Comorbidities.Curr Cardiol Rev. 2017;13(1):63-75.doi:10.2174/1573403x12666160803100928
Casu G, Merella P.Diuretic Therapy in Heart Failure - Current Approaches.Eur Cardiol. 2015;10(1):42-47. doi:10.15420/ecr.2015.10.01.42
Mtisi TF, Frishman WH.Beta Adrenergic Blocker Use in Patients With Chronic Obstructive Pulmonary Disease and Concurrent Chronic Heart Failure With a Low Ejection Fraction.Cardiol Rev.2020;28(1):20-25.doi:10.1097/CRD.0000000000000284
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