Heart failure (HF) is the inability of the heart to pump a sufficient amount of blood through its chambers to the body. This inability is typically caused by either reduced contractility and/or reduced filling of the heart chambers, leading to the symptom of dyspnoea. In chronic obstructive pulmonary disease (COPD), the destruction and re-modelling processes of the bronchiolar architecture inhibit proper exhalation of air, thereby leading to exhaustion of the chest muscles, insufficient oxygen delivery, and dyspnoea. Hence, heart failure and COPD represent the most important differential diagnoses of dyspnoea in elderly people.

One of the most common risk factors for COPD is tobacco smoking. There may be additional causes as well. These include genetic factors and workplace exposure to harmful gases or other toxins. Smoking is also a risk factor for heart disease, including heart failure. In addition, coronary artery disease, where heart vessels become blocked, can also result in heart failure, as can high blood pressure and heart valve problems.

Differences between COPD and heart failure

Both these problems can cause shortness of breath (dyspnoea), coughing, wheezing, chest pain or discomfort, palpitations, light-headedness or dizziness, fatigue, lethargy, muscle wasting, swelling in the lower extremities (more common in heart failure).

In both conditions, the shortness of breath is worse during activity than it is at rest. One difference is that although chest tightness is a common symptom of COPD, it does not usually occur with heart failure. Although wheezing is common with both COPD and heart failure, with the latter, your doctor may hear a “crackle” or “rales” in the lungs when listening through a stethoscope. This is the sound of the air moving through the fluid in the lungs.

A chest X-ray, electrocardiography (ECG), blood tests measuring natriuretic peptides (such as NT-proBNP), and echocardiography can all be used to identify the signs and symptoms of heart failure. Whereas, COPD can be diagnosed with the help of proper assessment of signs and symptoms, chest x-ray, spirometry (pulmonary function test) and CT-scan of the thorax.

Can COPD and heart failure co-exist?

These two conditions can clearly co-exist, and sometimes differentiating between the two conditions can pose a diagnostic challenge. There are concerns about missing the entity of heart failure with preserved Ejection Fraction (HFpEF) in a setting resembling COPD. Moreover, in patients with HFpEF, co-existing COPD is known to be associated with markedly worse symptoms and quality of life, compared to a situation where there is no such co-existence. Thus, it is important to seek medical attention as early as possible to get diagnosed and start the best possible treatment accordingly.