Cardiac disease in chronic obstructive pulmonary disease.
The cardiac manifestations of chronic obstructive pulmonary disease (COPD) are numerous. Impairments of right ventricular dysfunction and pulmonary vascular disease are well known to complicate the clinical course of COPD and correlate inversely with survival. The pathogenesis of pulmonary vascular disease in COPD is likely multifactorial and related to alterations in gas exchange and vascular biology, as well as structural changes of the pulmonary vasculature and mechanical factors. Several modalities currently exist for the assessment of pulmonary vascular disease in COPD, but right heart catheterization remains the gold standard. Although no specific therapy other than oxygen has been generally accepted for the treatment of pulmonary hypertension in this population, there has been renewed interest in specific pulmonary vasodilators. The coexistence of COPD and coronary artery disease occurs frequently. This association is likely related to shared risk factors as well as similar pathogenic mechanisms, such as systemic inflammation. Management strategies for the care of patients with COPD and coronary artery disease are similar to those without COPD, but care must be given to address their respiratory limitations. Arrhythmias occur frequently in patients with COPD, but are rarely fatal and can generally be treated medically. Use of beta-blockers in the management of cardiac disease, while a theoretical concern in patients with increased airway resistance, is generally safe with the use of cardioselective agents.
Falk
Jeremy A
JA
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center, for the David Geffen School of Medicine at UCLA, Los Angeles, California, USA. falkja@cshs.org
Kadiev
Steven
S
Criner
Gerard J
GJ
Scharf
Steven M
SM
Minai
Omar A
OA
Diaz
Philip
P
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D006328:Cardiac Catheterization; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D004232:Diuretics / Q000627:therapeutic use; D004452:Echocardiography; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000032:analysis; D010102:Oxygen Inhalation Therapy; D011013:Pneumonectomy; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D011659:Pulmonary Gas Exchange; D012307:Risk Factors; D014665:Vasodilator Agents / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D001993:Bronchodilator Agents; D004232:Diuretics; D014665:Vasodilator Agents; D020097:Natriuretic Peptide, Brain