The inflammatory responses and triggers of COPD exacerbations are heterogeneous, and these events are increasingly recognised as episodes with enhanced risks. As exacerbation diagnosis is based on symptoms rather than objective measures, other pathologies may mimic its presentation. Myocardial infarction and heart failure are common in exacerbating patients, and those with elevated cardiac biomarkers have increased odds for mortality. In additional to traditional risk factors, other or enhanced risk factors may contribute to the observed increase in cardiovascular risk during exacerbations. Furthermore, a high prevalence of pulmonary embolism has been observed in COPD patients with exacerbation, mainly in those with absence of lower respiratory tract infection symptoms or other obvious aetiologies. Healthcare professionals caring for COPD patients with exacerbations should be aware of the differential diagnosis of these events and consider additional diagnostics following clinical suspicion. The current literature suggests that diagnostic algorithms and pharmacological treatment of non-COPD-related events during COPD exacerbations are comparable to stable-state and other patient groups.

Cite as: Franssen FME, Vanfleteren LEGW. Differential diagnosis and impact of cardiovascular comorbidities and pulmonary embolism during COPD exacerbations. In: Burgel P-R, Contoli M, López-Campos JL, eds. Acute Exacerbations of Pulmonary Diseases (ERS Monograph). Sheffield, European Respiratory Society, 2017; pp. 114–128 [https://doi.org/10.1183/2312508X.10016316].