HOW IS HEART DISEASE DISTINGUISHED FROM LUNG DISEASE IN A PATIENT WITH DYSPNEA?
There are no reliable physical signs or symptoms that will always distinguish heart from lung causes of dyspnea when either may be present. Difficult diagnostic problems often occur in patients who may have either pulmonary or heart disease as a cause of dyspnea. Chronic obstructive pulmonary disease (COPD) is a common respiratory cause of dyspnea. Its treatment is different from primary (leftsided) heart failure, yet both can present with nearly identical symptoms and signs. For example, shortness of breath while lying down, swelling of the legs, and abnormal breathing sounds are all timehonored findings in both left heart failure and COPD. The most useful test to diagnose left heart failure in such patients is the routine chest xray. It shows an enlarged heart and congested pulmonary blood vessels in patients with leftsided CHF. When COPD is accompanied by right heart failure the xray will also show a large heart, but not the congested pulmonary blood vessels (unless left heart
