[The COPD-patient with acute dyspnea].
The presence of chronic obstructive pulmonary disease (COPD) is an important risk factor for cardiovascular comorbidity. Of note, cardiovascular diseases such as myocardial infarction or heart failure are - aside pulmonary cancer - the main reasons for the high morbidity and mortality in COPD patients. Heart failure is present in 20 - 30 % of COPD patients, but remains often under- or misdiagnosed. Subsequently, recommended treatment of heart failure in affected COPD patients could be improved. The difficulty in the diagnosis of heart failure related dyspnea in patients with known pulmonary disease is due to the lacking specificity of signs and symptoms for the diagnosis of cardiac or non-cardiac dyspnea. Thus, it is very important to consider a cardiovascular comorbidity in all COPD patients. Measurement of natriuretic peptides are extremely helpful to support the differentialdiagnosis of acute dyspnea in COPD patients in the emergency department. Using cut-off values of 100 pg/mL B-type natriuretic peptide (BNP) or 300 pg/mL N-terminal-proBNP have a high negative predictive value to exclude the presence of heart failure in COPD patients with acute dyspnea. Interpretation of plasma natriuretic peptide levels alone is not sufficient to "rule in" the diagnosis of left ventricular dysfunction in COPD patients. "Rule in" of the diagnosis of heart failure should therefore include the interpretation of patient history, physical and technical examinations such as echocardiography. In summary, measurement of natriuretic peptide levels in dyspneic patients with known pulmonary disease are helpful to exclude or support the diagnosis of heart failure related dyspnea.
Christ
Michael
M
Klinik für Notfall- und Internistische Intensivmedizin, Klinikum Nürnberg. michael.christ@klinikum-nuernberg.de
Heppner
Hans Jürgen
HJ
D000208:Acute Disease; D004417:Dyspnea / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*