Heart Failure Cough: A Persistent and Concerning Symptom

Azadeh Beheshtian | Jun 12, 2024

Heart failure is a chronic condition affecting millions worldwide. One significant but overlooked symptom is a persistent cough known as the heart failure cough. This cough can severely impact quality of life and indicate worsening heart failure. Heart failure occurs when the heart muscle weakens or stiffens, preventing effective blood pumping. This leads to fluid buildup in the lungs (pulmonary edema), a major cause of the cough. Other triggers include increased lung artery blood pressure, medication side effects like from ACE inhibitors, and underlying respiratory diseases. The cough persists for weeks or months, often worsening at night. It may produce phlegm/mucus or be dry. Worse when lying down as lung fluid shifts position. The cough frequently accompanies other heart failure symptoms like shortness of breath, wheezing, and swelling.

Effectively managing this cough involves treating the underlying heart condition to reduce fluid overload through medications, procedures, diet, and exercise. Diuretics remove excess fluid. Cough suppressants, bronchodilators for lung diseases, and oxygen therapy provide relief. Lifestyle changes like avoiding irritants and using humidifiers help. While a chronic cough is common, sudden onset of other concerning symptoms like coughing blood, fever, chest pain, or mental confusion requires prompt medical attention as they could signal serious complications. Overall, this persistent cough significantly impacts heart failure patients’ lives, so proper understanding and management are crucial.

Causes of the Heart Failure Coughing

There are several reasons why individuals with heart failure may experience a persistent cough:

• Pulmonary Edema: A primary cause of the heart failure cough is fluid buildup in the lungs, known as pulmonary edema. When the heart struggles to pump blood efficiently, excess fluid can accumulate in the lungs. This fluid irritates the airways, triggering a persistent, wet cough that may produce white or pinkish phlegm/mucus.
• Pulmonary Hypertension: Heart disease can sometimes lead to increased blood pressure in the blood vessels supplying the lungs, a condition called pulmonary hypertension. This increased pressure can cause fluid to leak into the lung tissue, resulting in a chronic cough, which is a common sign of heart failure.
• Medication Side Effects: Certain medications used to treat heart failure, such as angiotensin-converting enzyme (ACE) inhibitors, can sometimes cause a dry, persistent cough as a side effect.
• Comorbidities: Individuals with heart issues may also have other underlying conditions, like chronic obstructive pulmonary disease (COPD) or asthma, which can contribute to or exacerbate the persistent cough. These lung conditions can cause symptoms like wheezing, shortness of breath, and labored breathing alongside the cough.

Characteristics of the Heart Failure Cough

The heart failure cough is persistent and chronic. Unlike a temporary cough, it lasts for weeks or even months, making it one of the most common signs of congestive heart failure. This coughing can be either productive, expelling phlegm or mucus, or non-productive and dry. In cases of pulmonary edema or fluid buildup in the lungs, it is often a wet, productive cough as excess fluid is expelled from the body.

Some heart failure patients experience worsened coughing when lying down, as the accumulated lung fluid shifts position with the change in body position. This postural worsening is a characteristic symptom of the heart failure cough. Additionally, the persistent coughing frequently worsens at night, potentially disrupting sleep and further exacerbating fatigue and other symptoms of congestive heart failure like shortness of breath, labored breathing, and swelling in the legs.

The chronic coughing is commonly accompanied by other heart failure symptoms such as trouble breathing, wheezing, weight gain, fatigue, impaired thinking in severe cases, and even heart palpitations. Sudden changes like coughing up blood or chest pain require promptly seeking medical attention from a doctor.

Management Strategies for the Heart Failure Cough

Addressing the heart failure cough is crucial for improving a patient’s quality of life and managing the underlying condition effectively. Here are some strategies that may be employed:

1. Treating the Underlying Cause: The most effective way to manage the heart failure cough is to address the root heart problem itself. This may involve adjusting medications, implementing lifestyle changes like diet and physical activity, or considering advanced treatments like cardiac resynchronization therapy or implantable defibrillators.
2. Diuretic Therapy: Diuretics is often prescribed to help reduce fluid buildup in the lungs. By promoting the excretion of excess fluid, diuretics can alleviate pulmonary edema and potentially reduce the severity of the wet or dry cough.
3. Cough Suppressants: In some cases, healthcare providers may prescribe cough suppressants or over-the-counter medications to provide temporary relief from the persistent cough. However, it’s important to note that these only address the symptom and not the underlying pulmonary congestion causing the cough.
4. Bronchodilators: For individuals with congestive heart failure who also have concomitant respiratory conditions like COPD or asthma, bronchodilators may be prescribed to help improve airway function and alleviate coughing episodes along with other symptoms like wheezing and labored breathing.
5. Oxygen Therapy: In cases of severe pulmonary edema or low blood oxygen levels (hypoxemia) due to congestive heart failure, supplemental oxygen therapy may be recommended to improve oxygen delivery and potentially reduce the cough reflex and shortness of breath.
6. Lifestyle Modifications:

• Avoiding triggers like smoke, dust, and strong odors that can irritate the airways and exacerbate coughing fits
• Maintaining proper hydration to thin out mucus and make it easier to expel
• Using humidifiers or vaporizers to add moisture to the air, which can soothe irritated airways

Seeking Medical Attention

While a persistent chronic cough is one of the common heart failure symptoms, it’s crucial to seek medical care promptly if the cough is accompanied by any of the following concerning symptoms:

• Severe shortness of breath or labored breathing
• Coughing up blood or producing white/pinkish phlegm
• Chest pain or whistling sound when breathing
• Fever, chills, or other signs of infection (indicating it may not be just a heart failure cough)
• Sudden worsening of the cough, wheezing heavily, or worsening of other heart failure symptoms like excess fluid buildup

These additional symptoms could indicate a potentially serious underlying condition beyond just pulmonary edema from heart problems or a significant worsening of the heart failure itself. Things like coughing up blood require urgent evaluation to check for issues in the air sacs or lungs.

Summary

The cardiac cough or persistent cough related to congestive heart failure is often a debilitating symptom that can significantly impact the quality of life for those living with heart disease. Having a thorough understanding of the causes, characteristics, and management strategies for this chronic coughing is crucial for effective symptom management and improved overall well-being. By working closely with healthcare providers and implementing appropriate treatments tailored to the individual’s condition, as well as making recommended lifestyle modifications, heart failure patients can better manage this challenging symptom. Properly addressing the cardiac cough can potentially improve overall health outcomes for the body. Close coordination with one’s healthcare provider is key to successfully controlling this distressing aspect of heart failure.

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Frequently Asked Questions: Heart Failure Cough