One hundred patients aged 60 or older were studied clinically after excluding those with cardiac enlargement, definite valvular lesions or electrocardiographic (ECG) evidence of left ventricular hypertrophy. In 30 of the the 100 patients a significant systolic murmur was heard on auscultation. Phonocardiograms (PCGs), mitral echograms and pulse tracings were obtained in 28 of these 30 patients (2 had died meanwhile), and the ECGs and chest roentgenograms were reviewed. In 23 PCG patients there was an early or midsystolic murmur, best recorded at the base of the heart and often transmiteed to the apex. Mitral valve echograms and carotid and jugular pulse tracings were normal in all cases. Chest roentgenograms revealed aortic enlargement in 83 percent of the 23 patients. In the elderly with no evidence of organic heart disease, a basal systolic murmur is probably an aortic flow phenomenon caused by either moderate aortic dilatation or minimal fibrotic fusion of one or more commissures of the aortic valve.

BACKGROUND Chronic obstructive pulmonary disease is a leading cause of mortality and morbidity. Its effects extend beyond the respiratory system, to involve other organs like the heart and the brain. This study aimed to find out the relation between the severity of COPD as assessed by the CAT score and the echocardiographic abnormalities in subjects who did not have other comorbid conditions to influence the echocardiographic findings. METHODS The study population included 33 patients with a confirmed diagnosis of COPD based on pulmonary function tests. The study was done in Government Medical College, Thrissur, which is a tertiary care centre. RESULTS The study established that left ventricular diastolic dysfunction is a close accompaniment of COPD, more so as the severity of COPD increases. Another interesting observation is that it is the left ventricle which is more commonly affected in subjects with COPD, than the right ventricle even in subjects with pulmonary artery hypertension. CONCLUSIONS Left ventricular diastolic dysfunction is a well-established accompaniment of COPD, the severity of which has a linear relationship with the severity of COPD. Thus it becomes important to rule out decompensated heart failure during exacerbations of COPD.

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