Congestive Heart Failure (CHF) vs. Chronic Obstructive Pulmonary Disease (COPD)

Congestive Heart Failure (CHF) vs. Chronic Obstructive Pulmonary Disease (COPD)

Many signs and symptoms of CHF and COPD overlap, and many patients are diagnosed with both. Healthcare providers find it challenging to know which type of emergency a patient with difficulty breathing may be experiencing. Lung sounds are one way to help differentiate between CHF and COPD but are not always conclusive. A common rule is “treat the patient, not the lung sounds.”

While CHF and COPD patients both present with difficulty breathing, there are many differences between the two diseases that help healthcare providers differentiate the two.

Description - A disorder of the heart
that affects its ability to
pump effectively
- Affects smokers and
- Develops slowly, causing
a blockage of airflow and
respiratory problems due to
chronic bronchial
- Usually seen in smokers
Pathophysiology - Damaged ventricles and
pump failure
- Increased heart rate due
to compensation
- Enlarged left ventricle
- Fluid backs up into the
body when the heart fails
to pump adequately
- Loss of elasticity in the
alveolar spaces
- Inflamed airways
- Decreased airflow from
the lungs

Chronic Bronchitis
- Constantly irritated
- Extra mucus obstructs
the airways and alveoli
- Chronic low oxygen levels
Signs and symptoms - Difficulty breathing that
worsens when lying down
- Hypertension
- Tachycardia
- Rapid respirations
- Normal level of
- Difficulty breathing that
worsens with exertion
- Thin barrel chest
- Difficulty breathing upon
- Chest tightness
- Altered level of consciousness
and/or agitation
Skin signs - Pale or cyanotic
- Diaphoretic
- Pink
- Dry
Neck Veins - Distended neck veins - Flat neck veins
Lung sounds - Rales (crackles)
- “Wet” lung sounds
- Wheezing
- “Dry” lung sounds
Breathing - Difficulty breathing
with exertion
- Through pursed lips
Circulation - Dependent edema - No dependent edema
Cough/sputum - A cough may be present
when lying supine
- Pink frothy sputum
- Chronic cough
- Thick sputum
Patient’s medications - Diuretics
- Antihypertensives
- Home \(\text{O}_2\)
- Bronchodilators
- Corticosteroids
Treatment (based on
local protocols)
- High-flow \(\text{O}_2\) by
a non-rebreathing mask
- A continuous positive airway
pressure (CPAP) may be
- Seated upright with their
legs down
- Nitroglycerin may be
ordered if the systolic blood
pressure is greater than
100 mm Hg
- \(\text{O}_2\) delivery is
based on the patient’s oxygen
needs (can be low-flow via nasal
cannula or high-flow by a non-
rebreathing mask
- A continuous positive airway
pressure (CPAP) may be ordered
- Seated in a position of
If ordered and the patient is
prescribed a bronchodilator,
assist the patient with a
metered-dose inhaler


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