Güder G, Störk S
Medizinische Klinik und Poliklinik I, Kardiologie, Universitätsklinik Würzburg, Würzburg, Germany.
Deutsches Zentrum für Herzinsuffizienz Würzburg, Universitätsklinik, Universität Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany.
Herz. 2019 Sep;44(6):502-508. doi: 10.1007/s00059-019-4814-7.
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) represent the most important differential diagnoses of dyspnea in elderly people. Heart failure is the inability of the heart to pump sufficient amounts of blood through the cardiovascular system. Pump failure is caused by compromised contractility and/or filling of the ventricles leading to forward and backward failure and subsequently to dyspnea. In COPD, the destruction and remodeling processes of the bronchiolar architecture inhibit proper exhalation of air, thereby leading to exhaustion of the thoracic muscles, insufficient oxygen diffusion, and dyspnea. Despite these fundamental differences in the pathophysiology of both disorders, their clinical presentation may be very similar. This renders accurate and timely diagnosis and therapy, especially in patients with coexisting disease, difficult. This clinical review summarizes typical problems in the diagnosis of COPD, HF, and coincident disease, and describes strategies that help avoid misdiagnosis and ineffective treatment.
心力衰竭（HF）和慢性阻塞性肺疾病（COPD）是老年人呼吸困难最重要的鉴别诊断。心力衰竭是指心脏无法通过心血管系统泵出足够量的血液。泵功能衰竭是由心室收缩力受损和/或充盈受损导致的，进而导致前向和后向衰竭，随后引发呼吸困难。在慢性阻塞性肺疾病中，细支气管结构的破坏和重塑过程会抑制空气的正常呼出，从而导致胸肌疲劳、氧气扩散不足和呼吸困难。尽管这两种疾病在病理生理学上存在这些根本差异，但它们的临床表现可能非常相似。这使得准确及时的诊断和治疗变得困难，尤其是在患有合并症的患者中。本临床综述总结了慢性阻塞性肺疾病、心力衰竭和合并症诊断中的典型问题，并描述了有助于避免误诊和无效治疗的策略。
