Background COPD is one of the comorbidities in heart failure patients with a prevalence of around 10-41%. The mortality and morbidity increase in patients with concomitant HF and COPD. Case Description A-54-year-old man, smoker, complained dyspnea that worsen for 48 hours, orthopnea, worsening productive cough with thick phlegm for 1 week, diaphoresis, and fatigue. History of untreated COPD since 2014, dyslipidemia, heart attack, and hypertension since 2018. Examination: Obesity, HR 54x/min, RR 30 x/min, BP 140/90 mmHg, SpO2 96% on O2 4 lpm. JVP was increased, gallops, bilateral crackles, wheezing, and pre-tibial edema. WBC count was 15.000, Inferior OMI and LVH on ECG. Signs of pulmonary congestion, cardiomegaly, and increased Broncho-vascular pattern on chest X-ray. Echocardiography and cardiac marker testing were unavailable. The patient was diagnosed with ADHF and AECOPD. The patient was initially given furosemide IV, ramipril, spironolactone but didn’t improve. SABA-anticholinergic nebulization was added then and improved the symptoms. These medications were continued and added corticosteroid IV, antibiotics, aspirin in inward room. After 5 days of treatment, the patient improved, considered as outpatient and advised to control after 3 days. Discussion In the limited setting, manages patients with heart disease is challenging. History of untreated COPD, heart attack, hypertension, and dyslipidemia led the patient to this condition. There was no consensus in managing HF in the COPD population. Clinical consideration based on the dominant patient condition was suggested by some studies. This patient had significant improvement after combining diuretic, nebulization, and corticosteroid.

Background COPD is one of the comorbidities in heart failure patients with a prevalence of around 10-41%. The mortality and morbidity increase in patients with concomitant HF and COPD. Case Description A-54-year-old man, smoker, complained dyspnea that worsen for 48 hours, orthopnea, worsening productive cough with thick phlegm for 1 week, diaphoresis, and fatigue. History of untreated COPD since 2014, dyslipidemia, heart attack, and hypertension since 2018. Examination: Obesity, HR 54x/min, RR 30 x/min, BP 140/90 mmHg, SpO2 96% on O2 4 lpm. JVP was increased, gallops, bilateral crackles, wheezing, and pre-tibial edema. WBC count was 15.000, Inferior OMI and LVH on ECG. Signs of pulmonary congestion, cardiomegaly, and increased Broncho-vascular pattern on chest X-ray. Echocardiography and cardiac marker testing were unavailable. The patient was diagnosed with ADHF and AECOPD. The patient was initially given furosemide IV, ramipril, spironolactone but didn’t improve. SABA-anticholinergic nebulization was added then and improved the symptoms. These medications were continued and added corticosteroid IV, antibiotics, aspirin in inward room. After 5 days of treatment, the patient improved, considered as outpatient and advised to control after 3 days. Discussion In the limited setting, manages patients with heart disease is challenging. History of untreated COPD, heart attack, hypertension, and dyslipidemia led the patient to this condition. There was no consensus in managing HF in the COPD population. Clinical consideration based on the dominant patient condition was suggested by some studies. This patient had significant improvement after combining diuretic, nebulization, and corticosteroid.