Cardiopulmonary Syndrome

Cardiopulmonary syndrome is a term for when heart disease and chronic lung disease occur together in the same person and worsen each other. It is not the name of a single disease, but a description of two organs affected at the same time. Common combinations are COPD with heart failure, COPD with coronary artery disease, pauses in breathing during sleep with high blood pressure or atrial fibrillation, and chronic lung disease with high pressure in the lungs. An overview of how the heart and lungs are connected is covered on the Cardiovascular-Related Lung Disease page.

A Cycle That Worsens Both Organs

Chronic lung disease lowers oxygen levels and triggers inflammation throughout the body. The blood vessels in the lungs narrow, lung pressure rises, and the right side of the heart is strained, as covered on the Cor Pulmonale page. Overinflated lungs also reduce how well the heart fills. In turn, a weak heart causes fluid to back up in the lungs, making breathing harder, as covered on the Lung Disease Caused by Heart Disease page. A COPD flare-up or lung infection can trigger a heart attack and rhythm disorders in the weeks that follow, while worsening heart failure makes breathlessness in COPD worse.

Symptoms That Are Easily Confused

Shortness of breath, fatigue, cough, and leg swelling can come from either organ. As a result, one disease is often masked by the other: COPD in people with heart failure often goes unrecognized, and the reverse is also true. Lung function tests are also less accurate while the lungs are still congested with fluid, so they need to be repeated once the condition is stable. That is why symptoms that do not improve with treatment for one organ are a reason to examine the other.

One Plan for Two Organs

The recommended approach is a shared plan between a cardiologist and a pulmonologist. The majority of medications for both diseases can be used together. For example, cardioselective beta-blockers can generally still be used in COPD, and inhaled bronchodilators are generally safe for the heart with a doctor's monitoring. Quitting smoking, vaccinations, rehabilitation that trains the heart and lungs together, oxygen when levels are low, and an action plan for flare-ups help keep both organs stable.

Your doctor assesses the heart and lungs together, not one at a time. You will be asked about smoking, smoke exposure, flare-ups, and previous hospital stays, and your oxygen level will be measured. Spirometry assesses airflow in the lungs and should be done when your condition is stable, because fluid congestion can distort the results. An ECG, an NT-proBNP test, and echocardiography assess the heart's rhythm, strain, and pumping, as well as an estimate of lung pressure. A chest X-ray helps show the size of the heart, fluid, and changes in the lungs.

When it is still unclear which organ the symptoms come from, cardiopulmonary exercise testing can show whether the heart, lungs, or muscles are limiting your ability to be active. A sleep study is done if pauses in breathing during sleep are suspected, and a blood gas analysis if oxygen levels are low. If lung pressure is suspected to be high, right heart catheterization is used to confirm it. The combined results of these tests form the basis of a shared treatment plan.

Get checked if you have chronic heart or lung disease and your shortness of breath gets worse, new symptoms appear, or your ability to be active declines. If you smoke or used to smoke and have heart disease, ask for a lung function test. Go to the emergency room right away if you have severe shortness of breath or chest pain.

• Shortness of breath that gets worse even though you take your heart medications and inhalers regularly
• Leg swelling or rapid weight gain
• More phlegm or phlegm that changes color, with a fever
• Loud snoring, pauses in breathing during sleep, or excessive daytime sleepiness
• Heart palpitations or an irregular pulse
• Severe shortness of breath, chest pain, bluish lips, or confusion: go straight to the emergency room