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Herz

, Volume 44, Issue 6, pp 502–508 | Cite as

COPD and heart failure: differential diagnosis and comorbidity

  • G. GüderEmail author
  • S. Störk
Main topic

Abstract

Heart failure (HF) and chronic obstructive pulmonary disease (COPD) represent the most important differential diagnoses of dyspnea in elderly people. Heart failure is the inability of the heart to pump sufficient amounts of blood through the cardiovascular system. Pump failure is caused by compromised contractility and/or filling of the ventricles leading to forward and backward failure and subsequently to dyspnea. In COPD, the destruction and remodeling processes of the bronchiolar architecture inhibit proper exhalation of air, thereby leading to exhaustion of the thoracic muscles, insufficient oxygen diffusion, and dyspnea. Despite these fundamental differences in the pathophysiology of both disorders, their clinical presentation may be very similar. This renders accurate and timely diagnosis and therapy, especially in patients with coexisting disease, difficult. This clinical review summarizes typical problems in the diagnosis of COPD, HF, and coincident disease, and describes strategies that help avoid misdiagnosis and ineffective treatment.

Keywords

Pulmonary disease, chronic obstructive Aged Dyspnea Hypertension, pulmonary Treatment 

Abbreviations

COPD

Chronic obstructive pulmonary disease

FEV1

Forced expiratory volume in 1 s

FVC

Forced vital capacity

GOLD

Global Initiative for Chronic Obstructive Lung Disease

HF

Heart failure

HFpEF

Heart failure with preserved ejection fraction

HFrEF

Heart failure with reduced ejection fraction

LLN

Lower limit of normal

PH

Pulmonary hypertension

RV

Residual volume

TLC

Total lung capacity

COPD und Herzinsuffizienz: Differenzialdiagnose und Komorbidität

Zusammenfassung

Herzinsuffizienz und die chronisch obstruktive Lungenerkrankung (COPD) sind die häufigsten Differenzialdiagnosen der Dyspnoe bei älteren Patienten. Herzinsuffizienz beschreibt das Unvermögen des Herzens, die Organsysteme ausreichend mit Blut zu versorgen. Sie kommt entweder durch eine verminderte Kontraktion oder durch eine verminderte Füllung der Ventrikel zustande, mit der Folge eines Vorwärts- und/oder Rückwärtsversagens und Luftnot als klinischer Manifestation. Bei der COPD wird durch Verdickung und Zerstörung von bronchoalveolären Strukturen die Ausatmung behindert, was zur Übermüdung der Atmungsmuskulatur, einer gestörten Diffusion und Hypoxämie und damit zu Luftnot führt. Trotz der fundamentalen Unterschiede in der Pathophysiologie beider Erkrankungen sind klinische Präsentation und Symptomatik häufig sehr ähnlich. Dies erschwert die exakte und frühe Diagnose und Therapie, insbesondere auch bei Patienten, bei denen beide Erkrankungen gleichzeitig vorliegen. In dieser Übersichtsarbeit werden die klinischen Probleme bei der Diagnose von COPD, Herzinsuffizienz sowie dem gemeinsamen Vorliegen beider Erkrankungen beschrieben und Lösungen aufgezeigt, wie sich Fehldiagnosen verhindern lassen.

Schlüsselwörter

Lungenerkrankung, chronisch obstruktive Senioren Dyspnoe Hypertonie, pulmonale Therapie 

Notes

Compliance with ethical guidelines

Conflict of interest

G. Güder and S. Störk declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Medizinische Klinik und Poliklinik I, KardiologieUniversitätsklinik WürzburgWürzburgGermany
  2. 2.Deutsches Zentrum für Herzinsuffizienz Würzburg, UniversitätsklinikUniversität WürzburgWürzburgGermany

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