C5.11 Electrocardiography and echocardiography

Electrocardiography is indicated to confirm arrhythmias suspected on clinical grounds. Multifocal atrial tachycardia is a rare arrhythmia (prevalence < 0.32% of hospitalised patients) but over half the cases reported in the literature had underlying COPD. (McCord and Borzak, 1998) Atrial fibrillation commonly develops when pulmonary artery pressure rises, leading to increased right atrial pressure.

Echocardiography is useful if cor pulmonale is suspected, when breathlessness is out of proportion to the degree of respiratory impairment or when ischaemic heart disease, pulmonary embolus or left heart failure are suspected. Patients with COPD may have poor quality images on transthoracic examination and transoesophageal echocardiography may be frequently needed.

Consider COPD in patients with other smoking-related diseases (National Heart Lung and Blood Institute, 1998),(Decramer et al., 2005),(Holguin et al., 2005) [evidence level I]

Patients with COPD are prone to other conditions associ­ated with cigarette smoking, including accelerated cardio­vascular, cerebrovascular and peripheral vascular disease, and oropharyngeal, laryngeal and lung carcinoma. Con­versely, there is a high prevalence of COPD among patients with ischaemic heart disease, peripheral vascular disease and cerebrovascular disease and smoking-related carcinomas.(National Heart Lung and Blood Institute, 1998) These patients should be screened for symptoms of COPD, and spirometry should be performed.