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Thursday, September 18, 2014

People with end stage COPD now living longer

The natural progression of Chronic Obstructive Pulmonary Disease will eventually lead to heart failure.  When this happens the disease is considered to be in its end stages.  Good news here is that, while the prognosis is still quite poor, it has now been extended from two years to four hears, according to a study reported on in 2013 by the American Heart Association.  

Sometimes heart failure is caused by the aging process, simply by the it getting weak with age.  However, often it is secondary  to to the heart working too hard to pump blood through diseased lungs.  Patients with cystic fibrosis, bronchiectasis, and chronic obstructive pulmonary disease (COPD) are some of the lung diseases that may lead to heart failure. 

When heart failure is secondary to pulmonary disease, this usually begins by the right heart becoming enlarged (hypertrophic) from years of working too hard.  It then becomes an inefficient pump.  This is called cor pulmonale. 

Cor pulmonale may eventually lead to left heart failure, whereby the heart fails to meat the demands of the body.  Venous return to the heart increases, leading to blood becoming backed up in the legs, ankles, and lungs.  When blood backs up in the lungs this is called pulmonary edema.  It's also referred to as acute heart failure, or congested heart failure. 

There is no cure for heart failure, although the symptoms can be treated.  There are medicines to strengthen the force and contractility of the heart, and medicines to help remove the fluid from the lungs and ankles.  Acute heart failure may also be treated with noninvasive ventilation to reduce venous return and reduce cardiac output and blood pressure.  

Generally speaking, when patients with COPD develop heart failure it is considered end stage COPD.  This is where the patient will need to be monitored closely by a physician, and may require frequent physician and hospital visits in order to treat flare ups.  

At this point, flare ups may be caused by exposure to COPD triggers such as strong smells and cigarette smoke, but they may also be caused by heart failure. This is when treating the disease becomes difficult

Usually, patients with lung diseases develop atrial fibrilation prior to heart failure, so this may be a sign that it's time to consider heart failure.  

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