Featuring Dr. Sean Virani, MD, MSc, MPH, FRCPC, FCCS, Cardiologist and Dr. Donald Sin, MD, FRCP, MPH, Respirologist
Duration: 3 minutes, 15 seconds
Dr. Virani: Shortness of breath is a common feature of both heart failure and COPD. Complicating matters further is the fact that many patients with COPD will have heart failure and vice versa. So oftentimes it’s really challenging for the physician and for the patient to know whether their dysthymia is due to heart failure, COPD or both.
Dr. Sin: Many patients with COPD also have heart disease. It’s estimated that about four in ten COPD patients have a concomitant heart failure disorder. And both of these conditions cause shortness of breath, so diagnostically it may be very hard for you and your doctors to separate out COPD from heart failure—what’s causing what.
In this case, more advanced diagnostics may be required to really understand what’s driving your symptoms. Some of those diagnostics may include blood test; so there is a very sensitive blood test for heart failure—it’s called BNP. And that your doctor can order to see whether it’s the heart failure that’s driving the shortness of breath.
Dr. Virani: Natriuretic peptide testing is the gold standard for differentiating heart failure from COPD. Natriuretic peptides are elevated in patients with heart failure, however when levels are low it virtually excludes heart failure as a cause for the patient’s shortness of breath, leading us to think that COPD is probably the driver of their symptoms.
Dr. Sin: Another test that can be done is a chest x-ray to see if your lungs are full of water or full of holes, as in the case of emphysema. Another more sophisticated test would be a CT scan of your chest, and that would give you a very clear picture of the role that heart and lung is playing in driving the shortness of breath, or cough or recurrent chest infections.
Dr. Virani: It’s important to differentiate COPD from heart failure because the treatments will be clearly different, and so understanding the cause of the patient’s symptoms is paramount to understanding the best way to treat them.
Dr. Sin: It’s very important to sort out what’s driving the symptoms. Is it the heart failure? Is it the COPD? Or is it both? Because the treatment for these disorders are different. So for instance for heart failure, the treatment may be a water pill to relieve the pulmonary congestion. If it’s a COPD flare-up, it may be in the form of an inhaler, or antibiotics or a steroid to reduce the inflammation. So getting the diagnosis right in a specific patient is very, very important for how the therapeutics will treat those patients.
Dr. Virani: If you have patients with heart failure and COPD and are unclear about what the cause of their symptoms are, I’d encourage you to get a natriuretic peptide test done on your patient to help clarify the situation.
Presenter: Dr. Sean Virani, Cardiologist, Vancouver, BC
Local Practitioners: Cardiologist
