Chronic obstructive pulmonary disease (COPD) has significant extrapulmonary effects, among others, on cardiovascular disease. Heart failure can frequently be found in patients with COPD. Etiology of heart failure in COPD is only poorly understood but may be related to the high frequency of ischemic heart disease in this population. Furthermore, recent data suggest that diastolic left ventricular dysfunction may have a role for heart failure in COPD.