C5.11 Electrocardiography and echocardiography
Cardiovascular disease is common in patients with chronic obstructive pulmonary disease but is often under-recognised. Electrocardiography (ECG) may be useful to alert the clinician to its presence. In a retrospective Dutch study of patients entering pulmonary rehabilitation, ischaemic changes were present on ECG in 21% of all patients and in 14% of those without reported cardiovascular co-morbidity (Vanfleteren 2011). Electrocardiography is also indicated to confirm arrhythmias suspected on clinical grounds. Multifocal atrial tachycardia is a rare arrhythmia (prevalence < 0.32% of hospitalised patients) but over half the cases reported in the literature had underlying COPD (McCord 1998). Atrial fibrillation commonly develops when pulmonary artery pressure rises, leading to increased right atrial pressure.
Echocardiography is useful if cor pulmonale is suspected, when breathlessness is out of proportion to the degree of respiratory impairment or when ischaemic heart disease, pulmonary embolus or left heart failure are suspected. Patients with COPD may have poor quality images on transthoracic examination and transoesophageal echocardiography may be frequently needed.
Consider COPD in patients with other smoking-related diseases (National Heart Lung and Blood Institute 1998, Decramer 2005, Holguin 2005) [evidence level I].
Patients with COPD are prone to other conditions associated with cigarette smoking, including accelerated cardiovascular, cerebrovascular and peripheral vascular disease, and oropharyngeal, laryngeal and lung carcinoma. Conversely, there is a high prevalence of COPD among patients with ischaemic heart disease, peripheral vascular disease and cerebrovascular disease and smoking-related carcinomas (National Heart Lung and Blood Institute 1998). These patients should be screened for symptoms of COPD, and spirometry should be performed.< Prev Next >