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Associations between electrocardiographic and radiographic abnormalities with at least moderate interrater agreement and cardiac biomarkers were analysed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>High NT\u2010proBNP values (&gt;220 pmol\/L) were associated with atrial fibrillation (22 vs 6%), right ventricular hypertrophy (24 vs 15%), left ventricular hypertrophy (15 vs 4%), ischaemia (59 vs 33%) and cardiomegaly (42 vs 20%). High troponin T values (&gt;0.03ug\/L or high\u2010sensitivity &gt;50 ng\/L) were associated with tachycardia (65 vs 41%), right ventricular hypertrophy (26 vs 15%) and ischaemia (60 vs 36%). None of the electrocardiographic or radiographic abnormalities was sensitive or specific for cardiac biomarker abnormalities. Ischaemia on ECG was the best indicator for raised NT\u2010proBNP (sensitivity 59%, specificity 67%). Tachycardia and ischaemia were the best indicators of raised troponin T (sensitivity 65 and 60%, specificity 59 and 64% respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>ECG and chest radiograph abnormalities have poor sensitivity and specificity for diagnosing acute cardiac dysfunction in exacerbations of COPD. Cardiac biomarkers provide additional diagnostic information about acute cardiac dysfunction in exacerbations of COPD.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.14144","type":"journal-article","created":{"date-parts":[[2018,10,16]],"date-time":"2018-10-16T05:54:21Z","timestamp":1539669261000},"page":"761-769","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Cardiac dysfunction in exacerbations of chronic obstructive pulmonary disease is often not detected by electrocardiogram and chest radiographs"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1302-1703","authenticated-orcid":false,"given":"Eskandarain","family":"Shafuddin","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine Waikato Hospital  Hamilton New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherina L.","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Waikato Hospital  Hamilton New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manisha","family":"Cooray","sequence":"additional","affiliation":[{"name":"School of Medicine University of Auckland  Auckland New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kim A.","family":"McAnulty","sequence":"additional","affiliation":[{"name":"Department of Radiology Waikato Hospital  Hamilton New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noel C.","family":"Karalus","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Waikato Hospital  Hamilton New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcus H. 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