Cardiac injury in patients with COPD presenting with dyspnea: a pilot study

Abstract

Purpose:The aim of this pilot study was to test the hypothesis that myocardial ischemia complicates the management of some patients with chest-pain-free chronic obstructive pulmonary disease (COPD) exacerbations. Methods: In this prospective, observational, cohort study, patients admitted to a 350-bed community teaching hospital, with dyspnea and a primary diagnosis of COPD exacerbation, were followed for enzymatic and electrocardiographic evidence of myocardial ischemia for the first 24 hours of hospital admission. Results: A total of 114 patients were studied. Overall, four patients had definite myocardial infarctions, one had definite myocardial ischemia and 14 had possible myocardial ischemia. In multiple logistic regression models, age, number of coronary risk factors, and amount of administered albuterol were not associated with myocardial injury. Conclusion: While unrecognized myocardial injury is relatively rare in patients with an exacerbation of COPD, it occurs frequently enough to warrant some caution since beta-agonists are the mainstays of therapy.

Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Cardiovascular Links

“…At baseline, COPD patients have been shown to have higher highly sensitive cTnT than the general population [ 135 ]. Patients who present with AECOPD are often found to have elevated serum troponin [ 136 , 137 ], of which a minority are secondary to an acute coronary syndrome [ 96 , 137 – 139 ], often in the absence of chest pain [ 140 ]. In those admitted to hospital for an AECOPD, elevated serum troponins are correlated with long-term mortality [ 83 , 95 , 138 , 139 ], 30-day mortality [ 85 ], in-hospital mortality [ 142 ], increased length of stay [ 95 , 96 ] and risk of readmission [ 87 ].…”

Preventing adverse cardiac events (PACE) in chronic obstructive pulmonary disease (COPD): study protocol for a double-blind, placebo controlled, randomised controlled trial of bisoprolol in COPD

“… 4 In addition, a recent study demonstrated that COPD exacerbations (ECOPD) more than double the risk of myocardial infarction in the subsequent 5 days. 5 Subclinical ischaemic events and cardiac arrest occur more frequently after an exacerbation 6 and cardiac events are strong predictors of mortality in this setting. 7 In patients hospitalised with an ECOPD in Waikato, New Zealand, 8 elevated cardiac biomarkers were associated with a 15-times greater likelihood of dying within 30 days of admission than those without raised biomarkers and an 88% total mortality at 5 years.…”