Chronic obstructive pulmonary disease (COPD) and heart failure are different conditions. But both can make you short of breath when you do something physical, like exercise, climbing stairs, or walking for a long distance.
Breathing problems happen for different reasons with these conditions.
With COPD, it’s hard to exhale all of the air in your lungs because of lung damage, often from years of smoking.
If you have COPD, you most likely breathe comfortably when you’re at rest. But when you’re active, your breath starts coming in before air from your last exhale goes out. That causes shortness of breath.
If you have heart failure, your heart doesn’t pump blood efficiently. As with COPD, if you have heart failure, you can probably breathe easily when at rest. With activity, blood flow must increase, and your heart must pump harder and faster. If your heart can’t keep up, blood “backs up” into your lungs. This fluid congestion causes shortness of breath.
COPD and Left-Sided Heart Failure
Left-sided heart failure is most often caused by high blood pressure or coronary artery disease. It’s not directly related to COPD. But the two conditions may influence each other.
For example, low oxygen in the blood from COPD may put extra strain on your heart, which worsens left-sided heart failure. And too much fluid in your lungs from heart failure can make breathing even harder if you have COPD.
COPD and Right-Sided Heart Failure
Severe COPD can cause heart failure in your heart’s lower right chamber, or ventricle. This is a condition called right-sided heart failure or cor pulmonale.
Right-sided heart failure causes fluid to build up in your body, such as in your legs and belly area. Many conditions other than COPD also cause right-sided heart failure. Learn more about right-sided heart failure causes and symptoms.
Which Is It?
If you have both COPD and heart failure and find yourself short of breath, it can be hard to tell which condition is causing your breathing problems.
Your doctor may give you:
Physical examination: Listening to your lungs and heart, and looking at the veins in your neck, can help your doctor tell the difference between COPD and heart failure.
Chest X-ray: Heart failure may cause fluid in your lungs to be visible on a chest X-ray. With COPD, your lungs are usually clear or may look like they’re over-inflated. Find out what happens during a chest X-ray.
Brain natriuretic peptide (BNP) test: This hormone is usually at high levels in your blood if you have heart failure, whether or not you also have COPD.
Pulmonary function tests: Doctors can use breathing tests to diagnose COPD. Get more information on the different types of lung function tests.
Echocardiogram: An ultrasound test of your heart that can evaluate the heart chambers, valves, and pumping strength. Watch a video to see how an echocardiogram works.
Cardiac enzymes: This blood test can help diagnose a heart attack or too much strain on your heart. Read more on how heart disease is diagnosed.
Every case is different. Some people have severe COPD and only mild heart failure. Others have severe heart failure and only mild COPD. In these cases, the more severe condition is more likely to be the cause of breathing symptoms.
If COPD and heart failure are equally severe, doctors must make their best guess as to which condition is causing your symptoms.
To make things even more complicated, COPD and heart failure can at times act up at the same time. For example, if you have worsening heart failure symptoms that cause rapid breathing, this can make COPD symptoms worse, as well.
If your doctor can’t tell which condition causes your shortness of breath, they’ll probably treat both together.
Treatments for COPD focus on your lungs and your airways, the branching network of tubes inside the lungs. The main treatments for COPD are bronchodilators, which are inhaled medicines that help open the airways.
Heart failure treatments curb the workload on your heart and help prevent unhealthy growth of heart muscle. Several types of medicines do this.
If you have severe shortness of breath from COPD and heart failure, you may get other treatments, as well:
- Corticosteroids, such as prednisone or methylprednisolone (Solu-Medrol), which can improve breathing in people with COPD
- Antibiotics if any bacterial infection may be part of the problem
- Supplemental oxygen
- Non-invasive positive pressure ventilation, a form of machine-assisted breathing
- Mechanical ventilation, or temporary life support, through a breathing tube
- IV medicines to ease heart strain
And, if you have either condition and smoke, quitting should be a top priority for your health.
If you have both COPD and heart failure, a team of doctors will probably treat you, including a primary care physician, a cardiologist, and a pulmonologist, who is a doctor specializing in lung conditions.
Referenced on 16/05/2021
- Libby, P. Braunwald’s Heart Disease 8th Edition, W.B. Saunders, 2007.
- Mason, R. Murray and Nadel’s Textbook of Respiratory Medicine, 5th edition, Saunders, 2010.