Assessment of cardiovascular changes among chronic obstructive pulmonary disease patients at rural tertiary care center of Northern India

Background: Chronic obstructive pulmonary disease (COPD) is a complex systemic disease that has significant extrapulmonary effects along with pulmonary involvement. Cardiovascular manifestation is one of the most common comorbidities of COPD. Patients with COPD also carry an increased risk of mortality due to cardiovascular abnormalities compared with those who do not have these comorbidities. As the cardiac abnormalities clearly contribute to the overall mortality and morbidity associated with COPD, an understanding of their role and potential for treatment is vital; therefore, this study was done. Objectives: This study aimed to study the assessment of cardiovascular manifestation in COPD. Materials and Methods: This was a cross-sectional study done in the Respiratory Medicine Department of rural tertiary care center during the period from January 2015 to June 2016. A total of 200 study subjects fulfilling the inclusion criteria and consenting to participate were included in the study. The diagnosis of COPD is based on the clinical history, clinical examination, X-ray chest, and spirometry. All patients were further subjected to electrocardiogram (ECG) and two-dimensional echocardiography (2D-ECHO) for cardiac evaluation. Results: On ECG evaluation: Arrhythmia was found in 99 (49.5%) cases, right ventricular (RV) hypertrophy (RVH) in 61 (30.5%) cases, right atrial enlargement (RAE) in 52 (26%) cases, right bundle branch block in 20 (10%) cases, poor progression of R wave in 24 (12%) cases, and right axis deviation was found in 30 (15%) cases. On 2D-ECHO evaluation: tricuspid regurgitation was found in a 117 (58.5%) cases, pulmonary hypertension in 116 (58%) cases, RAE in 79 (39.5%) cases, RVH in 74 (37%) cases, RV enlargement in 55 (27.5%) cases, and left ventricular diastolic dysfunction in 113 (56.05%) cases. Conclusion: The study shows that cardiac disorders are highly prevalent in patients with severe-to-very severe COPD. ECHO is a simple non-invasive tool for evaluation of cardiac functions in patients with COPD during acute exacerbation as well as during the follow-up of the disease.