discussing the relation between the 2 diseases and the controversy in treatment strategy

1. COPD and Heart failure
Haytham Soliman, MD, FSCAI
Fayoum university

2. Synergism of heart failure and COPD
HF COPD
Clinical
picture
Morbidity
and
mortality
Prognosis
Complications
Pathophysiology
Biomarkers

5. Pathophysiology
HF
• Hypoxia
• lung hyperinflation
• secondary erythrocytosis
• loss of pulmonary vascular surface
area
• varying degrees of pulmonary
hypertension
COPD
• Both diastolic and systolic dysfunction
of the right and left ventricle
• Direct compromise of (RV)
• increased pulmonary vascular
resistance
• RV dilation and hypertrophy lead
to septum displacement to the left
ventricle
• Decrease LV filling, SV & CO
Inflammations
Endothelial dysfunction
Increase biomarkers
Arrhythmia
Loss of functional capacity

7. Shared symptoms

8. Prevalence of cardiac arrhythmias in COPD exacerbations. VPB ventricular premature
beats, SPB supraventricular premature beats, SVT supraventricular tachycardia, AF atrial
fibrillation, NSVT non-sustained ventricular tachycardia, PAF paroxysmal atrial
fibrillation, SustVT sustained ventricular tachycardia Rusinowicz T., Zielonka T.M., Zycinska K. (2017) Cardiac Arrhythmias in
Patients with Exacerbation of COPD. In: Pokorski M. (eds) Clinical
Management of Pulmonary Disorders and Diseases. Advances in
Experimental Medicine and Biology, vol 1022. Springer, Cham

13. Spirometer to establish the
diagnosis of COPD with HF

14. Pitfalls in diagnostic imaging
• Transthoracic echocardiography can miss findings in up to 10%
of COPD patients due to poor window
• Transesophageal echocardiography can have better precision in
poor window patients but needs either heavy sedation or non
invasive ventilations
• CMR if feasible is considered the gold standard evaluation tools of LV
functions these patients and could additionally estimate myocardial
fibrosis and predict the risk of arrhythmias in
COPD patients

15. Cardiologist Pulmonologist
No beta agonist
No pulmonary
function test
No beta blockers
SteroidsYou are the cause of
:
Arrhythmia
Dyspnea

16. Beta blockers underuse in HF & COPD

17. • 557 of 5,162 patients (11%) received β-blockers at baseline
• Follow up was 52 weeks
• Testing the Lung function, overall respiratory status, and safety of
tiotropium/olodaterol influenced by baseline β-blocker treatment

19. ESC heart failure guidelines 2016

20. Bronchodilators and inhaled steroids
• Short acting B2 agonist induce arrhythmia and must be avoided in
long term management but must be used if needed in acute settings
• Long acting B agonist (LABA) and inhaled steroids a proven safe for
patients with CV diseases
• Also long acting muscarinic agonists (LAMAS) have proven safe,
effective with no increase in CV events

27. Summary
• COPD has many interactions with heart failure
• It increases the morbidity and mortality of the disease
• Discrimination of both diseases can be difficult
• BNP levels and spirometer must be used to establish solid diagnosis
• Beta blockers are safe in COPD patients
• LABAs, LAMAS and inhaled steroids are safe in HF patients
• Diagnostic and therapeutic algorithms are corner stones in managing
HF with COPD

28. Thank
you