Chronic Obstructive Pulmonary Disease and Your Heart

If you have chronic obstructive pulmonary disease (COPD), you may be a lot more focused on your lungs than on your heart. Yet these two organ systems are intimately connected—each other's "right hand man"—and the health of one system can significantly affect the health of the other.

Researchers have long known that advanced COPD can harm the heart. Now, a 2010 study in The New England Journal of Medicine indicates that even mild cases of COPD can be associated with diminished heart function. While that may not sound like good news, there is an upside. You can take steps to help your lungs and your heart—and the sooner you take them the better.

The Heart-Lung Connection

The heart and lungs work together to deliver oxygen to and remove carbon dioxide from the body's tissues. When you inhale, oxygen enters the blood via little sacs in the lungs called alveoli. The oxygenated blood travels through the pulmonary veins to the left side of the heart, where it is pumped throughout the body. The deoxygenated blood then returns to the right side of the heart and is pumped through the pulmonary arteries to the lungs. When you exhale, carbon dioxide exits your body and the cycle starts again.

But this process can go awry in people with COPD. Low oxygen levels in the alveoli cause the pulmonary arteries to constrict (narrow) and the normally low pressure in the arteries to rise. If the pressure in the pulmonary arteries rises to a sufficiently high level, a condition called secondary pulmonary hypertension develops.

In pulmonary hypertension, the right side of the heart must work harder to push blood through the pulmonary arteries into the lungs. Over time, the heart's right ventricle becomes thick and enlarged and the heart's pumping action may deteriorate. The result of this damage may be heart failure.

In a person with left heart failure, fluid builds up in the lungs and other organs as well as in the arms and legs, causing fatigue and breathlessness on exertion. The condition also increases the risk of pulmonary emboli (blood clots in the lung), which can further block blood vessels in the lungs. When right-sided heart failure results from a lung disorder, fluid builds up in the legs and arms but less so in the lungs, and it is referred to as cor pulmonale.

Early Lung Damage, Early Heart Damage

Researchers have long known that advanced COPD can lead to heart failure. In fact, the two conditions often coexist, and people with both conditions have a poorer prognosis than those who have either condition alone.

For instance, studies have shown that people with COPD and heart failure are hospitalized more frequently, have longer hospital stays, and are at increased risk for dying of cardiovascular disease. The study in The New England Journal of Medicine is the first to show that the initial signs of heart trouble can occur in the earliest stages of COPD, when symptoms are mild.

Using magnetic resonance imaging (MRI) and computed tomography (CT) scans as well as breathing tests, researchers assessed the structure and function of the hearts and lungs of 2,816 generally healthy adults who ranged in age from 45 to 84. Of the participants, 13 percent were smokers, 38 percent were former smokers, and 49 percent never smoked.

The investigators found impaired heart and lung function in many of the participants, including those with mild COPD—a sign that changes in the heart occur much earlier than previously believed. What's more, the link between heart disease and COPD was most pronounced in current smokers, particularly those with emphysema.

In fact, the effect of emphysema on the heart in smokers was greater than that of traditional heart risk factors such as high blood pressure.

Keeping Your Heart Healthy

While researchers are uncertain whether treating COPD will improve heart function, much of what you may already be doing to live more comfortably with COPD will benefit your heart as well. Here are the three most important lifestyle changes to make on behalf of your heart and lung health:

  1. Stop smoking. This is a key step in slowing the deterioration of your lungs and your heart. Each time you take a puff, the nicotine temporarily increases your heart rate and depletes oxygen from the blood. Smoking causes blood vessels to constrict, forcing the blood to travel through a smaller space and causing higher blood pressure. Smoking also lowers high-density lipoprotein (HDL) cholesterol—the good cholesterol—contributing to the development of hardened arteries and increasing the risk of thrombosis (blood clots blocking a blood vessel). Over time, these effects of smoking add up to an increased risk not only of developing heart failure but also of having a heart attack. (If you need help quitting, talk to your doctor or go to www.smokefree.gov or www.lungusa.org/stop-smoking/how-to-quit.)
  2. Start exercising. Regular moderate exercise can strengthen your heart, lower your blood pressure, and improve circulation and cholesterol levels. The severity of your COPD will determine specifically what kinds and what amount of exercise you can tolerate, but here are some general guidelines:
    • Always try to breathe slowly. Shortness of breath—a common symptom of both COPD and heart failure—is an indication that your body needs more oxygen. A technique known as pursed lip breathing can help restore oxygen to your system more rapidly. To do it, inhale through your nose, keeping your mouth closed; then, exhale through pursed lips. Try to breathe out for twice as long as you breathe in.
    • Avoid exercising outdoors when it's too cold, too hot or humid. High humidity might cause you to become fatigued more quickly. In addition, extreme temperatures can interfere with blood circulation, making breathing difficult and, in some cases, causing chest pain. But don't let bad weather keep you from exercising. Instead, try indoor activities such as walking on a treadmill.
    • Do not ignore pain. If you have chest pain or pain anywhere else in your body or you feel weak or dizzy, stop exercising and rest. If symptoms continue after a few minutes of rest, get medical help right away.
    • Consider pulmonary rehabilitation. If you find it too exhausting to exercise, ask your doctor about pulmonary rehabilitation. This type of program has been shown to increase exercise tolerance, reduce breathlessness, and improve quality of life in individuals with COPD. These programs are offered by hospitals on an outpatient basis and typically focus on strengthening your major muscles so that you can be more active.
  3. Eat well. Your diet is one of your best weapons against heart disease. Making healthy food choices—fresh fruits and vegetables, whole-grain bread and pasta, fat-free dairy products, fatty fish, lean meats, and skinless poultry—can help you control your weight, your blood pressure and your cholesterol levels. As COPD advances, you may not feel like eating anything at all, but good nutrition is crucial to give you more energy and to help fight off infections. If you have advanced COPD, particularly if you have heart failure, ask your doctor to refer you to a nutritionist. He or she can help you set up an eating plan that meets all of your nutritional requirements.

Medication Issues Related to COPD and Heart Disease

Beta-blockers, such as carvedilol (Coreg) and metoprolol (Toprol XL), are commonly prescribed for heart failure because they decrease the heart's workload and improve survival. However, they are often not prescribed for heart failure in people with COPD for fear that they may worsen airway obstruction. Yet, this doesn't seem to be a problem with "specific" beta-blockers, such as Toprol XL, that affect the blood vessels much more than the lungs.

Anticholinergics, such as ipratropium (Atrovent) and tiotropium (Spiriva), appear safe for patients with heart failure. But short-acting beta2 agonists, such as albuterol (Proventil, Ventolin) and levalbuterol (Xopenex), may exacerbate heart failure. If you're using one of these medications, ask your doctor about switching to a long-acting beta2 agonist, such as formoterol (Foradil) or salmeterol (Serevent). It's important to note that these medications may on occasion be associated with irregular heart rhythms.

If you have COPD, talk to your internist about your heart or see a cardiologist, sooner rather than later. Identifying any issues with your heart early—along with regular monitoring, some basic lifestyle changes and the right medications—can help improve the health of both your heart and your lungs.

Publication Review By: Peter B. Terry, M.D., M.A.

Published: 08 Aug 2011

Last Modified: 23 Jul 2015