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PROBLEM
A 70-year-old patient presents with increasing dyspnea. She has been a smoker and has chronic obstructive pulmonary disease (COPD). What is the most effective means of determining whether COPD or congestive heart failure (CHF) is the cause of her breathlessness?
APPROACH
The need to distinguish dyspnea caused by heart disease from that caused by lung disease is a common problem. Considerable overlap exists in the associated risk factors and accompanying signs and symptoms. In patients with moderate or severe COPD, any factor that increases cardiovascular requirements or alters cardiac efficiency can cause an exacerbation of pulmonary problems. Ultimately, the results of the history, physical examination, and testing are used to determine which condition is more probable given the evidence for both conditions.
HISTORY AND PHYSICAL EXAMINATION
When lung or cardiac disease causes dyspnea, the disease is usually evident on clinical evaluation. Factors that suggest, but do not confirm a pulmonary etiology include a history of lung disease, including asthma,...