When someone with both COPD and heart failure experiences shortness of breath, identifying which condition is causing the symptoms can be difficult. Most people with both COPD and heart failure cannot distinguish between the symptoms of each condition.

Doctors cannot consistently or accurately tell the two apart, either. When someone with both heart failure and COPD seeks help for breathing difficulty, a doctor may use various tests to gauge the activity of each condition, including:

• Physical examination: Listening to the lungs and heart, and looking at the veins in the neck, can give a doctor reason to suspect COPD or heart failure.
• Chest X-ray: Heart failure may cause fluid in the lungs to be visible on a chest X-ray; in COPD, the lungs are usually clear.
• Brain natriuretic peptide (BNP): This hormone is usually elevated on blood tests in people with heart failure, whether or not COPD is also present.
• Pulmonary function tests: Breathing tests can be used to diagnose people with COPD.
• Echocardiogram: An ultrasound test of the heart that can evaluate the heart chambers, valves, and pumping strength.
• Cardiac enzymes: This blood test can help diagnose a heart attack or excessive heart strain.
• Some people have severe COPD and only mild heart failure; others have severe heart failure and only mild COPD. In these cases, the more severe condition is more likely to be the cause of symptoms.

In people with COPD and heart failure of about equal severity, doctors must make their best guess as to which condition is causing symptoms.

Making things even more complicated, COPD and heart failure can at times act up simultaneously. For example, if someone has worsening heart failure symptoms that cause rapid breathing, this can cause COPD symptoms to worsen as well.

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