scholarly journals Cardiovascular and chronic obstructive pulmonary diseases: pathophysiological processes and treatment tactics

2020 ◽  
Vol 92 (3) ◽  
pp. 78-83
Author(s):  
L. G. Ambatiello ◽  
I. E. Chazova
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Lifestyle Changes ◽  
Pulmonary Diseases ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Chronic Obstructive Pulmonary Diseases ◽  
Close Relationship ◽  
Global Aging

Due to the global aging of the population, the deteriorating ecology and lifestyle changes, patients with isolated cardiovascular diseases (CVD) are becoming less common, and the portrait of a comorbid patient comes first in the structure of patients with CVD. Among a number of diseases complicating and concomitant with cardiovascular, a special place is occupied by chronic obstructive pulmonary disease (COPD). The prevalence of COPD among CVD patients can reach 60%. Many of the pathophysiological mechanisms underlying COPD can increase the risk of cardiovascular disease and vice versa. The most common cases of COPD are arterial hypertension, coronary heart disease, heart failure, and atrial fibrillation. Given the close relationship between COPD and CVD, it is clear that treatment for one condition can affect another. This review discusses current positions about the influence of both groups of diseases on each other, and also observes the effects of drug therapy of both diseases.

Characteristics and outcomes of adults with chronic obstructive pulmonary disease and atrial fibrillation

Heart ◽  
2018 ◽  
Vol 104 (22) ◽  
pp. 1850-1858 ◽  
Author(s):  
Michael T Durheim ◽  
DaJuanicia N Holmes ◽  
Rosalia G Blanco ◽  
Larry A Allen ◽  
Paul S Chan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Symptom Burden ◽  
Smoking History ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

ObjectiveChronic obstructive pulmonary disease (COPD) is associated with the development of atrial fibrillation (AF), and may complicate treatment of AF. We examined the association between COPD and symptoms, quality of life (QoL), treatment and outcomes among patients with AF.MethodsWe compared patients with and without a diagnosis of COPD in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, a prospective registry that enrolled outpatients with AF not secondary to reversible causes, from both academic and community settings.ResultsAmong 9749 patients with AF, 1605 (16%) had COPD. Relative to patients without COPD, those with COPD were more likely to be older, current/former smokers (73% vs 43%), have heart failure (54% vs 29%) and coronary artery disease (49% vs 34%). Oral anticoagulant and beta blocker use were similar, whereas digoxin use was more common among patients with COPD. Symptom burden was generally higher, and QoL worse, among patients with COPD (median Atrial Fibrillation Effect on QualiTy-of-Life score 76 vs 83). Patients with COPD had higher risk of all-cause mortality (adjusted HR 1.52 (95% CI 1.32 to 1.74)), cardiovascular mortality (adjusted HR 1.51 (95% CI 1.24 to 1.84)) and cardiovascular hospitalisation (adjusted HR 1.15 (95% CI 1.05 to 1.26)). Patients with COPD also had higher risk of major bleeding events (adjusted HR 1.25 (95% CI 1.05 to 1.50)). There did not appear to be associations between COPD and AF progression, ischaemic events or new-onset heart failure.ConclusionsAmong patients with AF, COPD is associated with higher symptom burden, worse QoL, and worse cardiovascular and bleeding outcomes. These associations were not fully explained by cardiovascular risk factors, AF treatment or smoking history.Clinical registration numberNCT01165710

scholarly journals Evaluation of diagnostic criteria of heart failure in patients with atrial fibrillation and chronic obstructive pulmonary disease

Kardiologiia ◽  
2019 ◽  
Vol 59 (10S) ◽  
pp. 4-12
Author(s):  
T. A. Dzyurich ◽  
A. I. Chesnikova ◽  
V. P. Terentyev ◽  
O. E. Kolomatskaya ◽  
V. A. Safronenko
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Clinical Symptoms ◽  
Chronic Obstructive ◽  
Right Heart ◽  
Obstructive Pulmonary Disease ◽  
Left And Right

Aim. Assess the diagnostic significance of markers of heart failure, to identify the features of clinical symptoms and structural and functional remodeling of the left and right heart in patients with chronic heart failure (CHF) in combination with atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD). Materials and methods. groups of patients were formed: group 1 – patients with COPD without cardiovascular diseases (n=28), group 2 – patients with CHF and COPD without AF (n=30), group 3 – patients with CHF and AF without COPD (n=33), group 4 (main) – patients with CHF, AF and COPD (n=29). Patients were evaluated for clinical symptoms, 6-minute walk test, echocardiographic study, determined the concentration of natriuretic peptides (NUP): N-terminal fragment of the precursor of cerebral NUP (NT-proBNP) and mid-regional pro-atrial NUP (MR-proANP). Results. In patients with CHF on the background of AF and COPD, a higher score of the severity of clinical symptoms was established in comparison with the 3rd group (p<0,001). The features of heart remodeling in patients of the main group were revealed in comparison with patients with CHF and AF without COPD: lower volume indices of the left (p=0,001) and right (p=0,004) atria and values of the indexed index of the end-diastolic area of the right ventricle (RV) (p=0,007), lower contractility of the RV, the presence of RV hypertrophy. The effect of AF on the structural and functional parameters of the heart in patients with CHF, COPD and AF can be judged by comparison with patients with CHF and COPD without AF: higher values of the size of the RV (p=0,012), indexed index of the end-systolic area of the RV (p<0,001), lower systolic function of the RV on the background of higher pressure in the RV cavity (p=0,001). Defined the highest level of NT-proBNP in patients with CHF, AF and COPD in comparison with its level in patients of the 2nd group (p<0,001) and in patients 3rd groups (p=0,010). Higher levels of MR-proANP were found in patients with CHF and AF without COPD (p<0,001). Conclusion. In patients with CHF, AF and COPD, more pronounced clinical symptoms are caused by chronic bronchial obstruction. Pathogenetic features of left and right heart remodeling in patients with CHF on the background of AF and COPD were revealed. For the early detection of HF in patients with AF the greatest diagnostic importance is the determination of the level of MR-proANP, however, in patients with combined AF and COPD the most informative is the determination of the concentration of NT-proBNP.

scholarly journals Comparative analysis of the diagnostic significance of heart failure markers in comorbid patients with atrial fibrillation and chronic obstructive pulmonary disease

2019 ◽  
Vol 10 (1) ◽  
pp. 20-27 ◽  
Author(s):  
Tatiana A. Dzyurich ◽  
Anna I. Chesnikova ◽  
Vladimir P. Terentyev ◽  
Olga E. Kolomatskaya
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Comparative Analysis ◽  
Chronic Heart Failure ◽  
Pulmonary Disease ◽  
Natriuretic Peptides ◽  
Chronic Obstructive ◽  
Diagnostic Significance ◽  
Obstructive Pulmonary Disease

Objective:to assess the diagnostic significance of atrial and brain natriuretic peptides for the detection of chronic heart failure in comorbid patients with atrial fibrillation and chronic obstructive pulmonary disease.Materials and methods:120 patients depending on the presence of chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF) and atrial fibrillation (AF) were divided into the following groups: I group (n=28) — patients with COPD without cardiovascular disease (CVD), II group — patients with CHF and COPD without AF (n=30), III group — patients with CHF and AF without COPD (n=33), IV group — patients with CHF, AF and COPD (n=29). Th e concentration of precursors of brain and atrial natriuretic peptides (NUP) (NT-proBNP and MR-proANP) was evaluated.Results:The level of NT-proBNP exceeded the reference values in all patients with CHF (I, II, III groups). In patients with CHF, AF and COPD the highest values of NT-proBNP concentrations were obtained, which were 2.2 times higher in the group of patients with CHF and COPD without AF (p=0.000) and 1.9 times higher in patients with CHF and AF without COPD (p=0.01). Comparative analysis of the MR-proANP level allowed to judge a higher concentration of this indicator in patients with CHF and COPD without COPD in comparison with the level of the marker in the groups of patients with CHF, AF and COPD (p=0.001), CHF and COPD without AF (p=0.000) and COPD without CVD (p=0.000).Conclusions:in patients with AF and COPD, the study of brain NUP NT-proBNP in connection with structural and functional changes of the right ventricle, against the background of existing cardiac arrhythmias and pulmonary pathology is preferable to determine the presence and severity of CHF. The elevated level of MR-proANP is of diagnostic value in patients with AF and CHF without COPD, due to the increased volume load on the Atria due to the presence of AF.

Upper Limb Extremity Muscle-Dysfunction in Chronic Obstructive Pulmonary Disease: A Narrative Review

2020 ◽  
Vol 16 (1) ◽  
pp. 11-20
Author(s):  
Kulkarni M. Suhas ◽  
Gopala K. Alaparthi ◽  
Shyam K. Krishnan ◽  
Kalyana C. Bairapareddy
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Upper Extremity ◽  
Upper Limb ◽  
Pulmonary Diseases ◽  
Chronic Obstructive ◽  
Muscle Dysfunction ◽  
Obstructive Pulmonary Disease ◽  
Rehabilitation Protocol ◽  
Chronic Obstructive Pulmonary Diseases

Background: Peripheral muscle dysfunction is one of the major comorbidities seen in chronic obstructive pulmonary disease. Focusing more on upper extremity, unsupported elevation of arms results in a change in the recruitment pattern of the respiratory muscles. Over the years, many tests were developed to assess the upper limb capacity and include them in various rehabilitation protocol. Objective: To review the evidence on mechanism, tests, and rehabilitation protocol for the upper limb extremity muscle-dysfunction occurring in chronic obstructive pulmonary disease. Methods: PubMed and Google scholar databases were searched. Based on the inclusion criteria’s:- Chronic Obstructive Pulmonary Diseases patients, any Randomized Controlled or clinical trials, systematic reviews, explaining upper limb extremity muscle dysfunction, various tests to assess upper limb functional capacity and different ways of upper limb extremity training, a total of 15 articles were retrieved. Results: The mechanism of upper extremity muscle dysfunction is now well understood. Various tests were designed in order to assess arm strength, arm endurance and functional capacity. All the studies which included upper limb extremity training as a part of the rehabilitation program, showed beneficial results in terms of reduction of dyspnoea and arm fatigue, as well as improving the activity performing capacity. Conclusion: This review concluded that the alteration in the upper limb extremity muscles is an inevitable consequence of chronic obstructive pulmonary diseases, which can be confirmed by various upper extremity tests, with patients responding positively to the upper limb training incorporated during pulmonary rehabilitation protocols.

scholarly journals Chronic obstructive pulmonary disease and atrial fibrillation

2021 ◽  
Vol 2 (4) ◽  
pp. 22-29
Author(s):  
S. E. Glova ◽  
I. V. Razumovsky
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Underlying Disease ◽  
Chronic Obstructive ◽  
Rapid Progression ◽  
Obstructive Pulmonary Disease ◽  
First Line Therapy ◽  
Copd Patients ◽  
Close Relationship

Chronic obstructive pulmonary disease (COPD) has a close relationship with the development of heart failure and atrial fibrillation (AF). In the pathogenesis of AF in patients with COPD, decreased oxygenation, hypercapnia, pulmonary hypertension, diastolic dysfunction, oxidative stress, inflammation, changes in atrial size, and the use of respiratory drugs for the treatment of COPD are important. Understanding the relationship between COPD and AF is of particular importance because the presence of arrhythmias has a significant impact on mortality, especially in exacerbations of COPD. In the presence of COPD, patients with AF have a more rapid progression of AF, recurrence of AF after catheter ablation, and an increase in mortality from cardiovascular diseases. Treatment of the underlying disease, correction of hypoxia and acid‑base imbalance is the first line therapy for patients with COPD who develop AF. Cardioselective β‑blockers are safe and can be used for COPD. AF ablation is effective and safe and improves the quality of life of these patients.

Acute breathlessness

2018 ◽  
Author(s):  
Jonathan Timperley ◽  
Sandeep Hothi
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Embolism ◽  
Older Patients ◽  
Decompensated Heart Failure ◽  
Chronic Obstructive ◽  
Clinical Approach ◽  
Obstructive Pulmonary Disease ◽  
New Onset

Acute breathlessness or dyspnoea is the new onset of an unpleasant awareness of breathing, at rest or at a level of exercise, which did not previously cause symptoms. It is often associated with other symptoms—including wheeze, cough, chest pain, and palpitation—which, together with the patient’s comorbidities, help shape the differential diagnosis. Five disorders—decompensated heart failure, exacerbations of asthma or chronic obstructive pulmonary disease, pneumonia, and pulmonary embolism—account for 80% of diagnoses. In older patients, acute breathlessness often results from multiple interrelated pathologies (e.g. pneumonia on a background of COPD, triggering acute atrial fibrillation). This chapter describes the clinical approach to the patient presenting with acute breathlessness.

scholarly journals Predicting 10-year stroke mortality: development and validation of a nomogram

2021 ◽  
Author(s):  
Weronika A. Szlachetka ◽  
Tiberiu A. Pana ◽  
Mamas A. Mamas ◽  
Joao H. Bettencourt-Silva ◽  
Anthony K. Metcalf ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Coronary Heart Disease ◽  
Point Of Care ◽  
Chronic Obstructive ◽  
Stroke Mortality ◽  
Peripheral Vascular ◽  
Anterior Circulation ◽  
Obstructive Pulmonary Disease

AbstractPredicting long-term stroke mortality is a clinically important and unmet need. We aimed to develop and internally validate a 10-year ischaemic stroke mortality prediction score. In this UK cohort study, 10,366 patients with first-ever ischaemic stroke between January 2003 and December 2016 were followed up for a median (interquartile range) of 5.47 (2.96–9.15) years. A Cox proportional-hazards model was used to predict 10-year post-admission mortality. The predictors associated with 10-year mortality included age, sex, Oxfordshire Community Stroke Project classification, estimated glomerular filtration rate (eGFR), pre-stroke modified Rankin Score, admission haemoglobin, sodium, white blood cell count and comorbidities (atrial fibrillation, coronary heart disease, heart failure, cancer, hypertension, chronic obstructive pulmonary disease, liver disease and peripheral vascular disease). The model was internally validated using bootstrap resampling to assess optimism in discrimination and calibration. A nomogram was created to facilitate application of the score at the point of care. Mean age (SD) was 78.5 ± 10.9 years, 52% female. Most strokes were partial anterior circulation syndromes (38%). 10-year mortality predictors were: total anterior circulation stroke (hazard ratio, 95% confidence intervals) (2.87, 2.62–3.14), eGFR < 15 (1.97, 1.55–2.52), 1-year increment in age (1.04, 1.04–1.05), liver disease (1.50, 1.20–1.87), peripheral vascular disease (1.39, 1.23–1.57), cancers (1.37, 1.27–1.47), heart failure (1.24, 1.15–1.34), 1-point increment in pre-stroke mRS (1.20, 1.17–1.22), atrial fibrillation (1.17, 1.10–1.24), coronary heart disease (1.09, 1.02–1.16), chronic obstructive pulmonary disease (1.13, 1.03–1.25) and hypertension (0.77, 0.72–0.82). Upon internal validation, the optimism-adjusted c-statistic was 0.76 and calibration slope was 0.98. Our 10-year mortality model uses routinely collected point-of-care information. It is the first 10-year mortality score in stroke. While the model was internally validated, further external validation is also warranted.

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