Heart Failure Cough: A Persistent and Concerning Symptom

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

Free Sick Woman On The Bed Stock Photo

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

Free Woman in Gray Tank Top Lying on Bed Stock Photo

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.


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.

Experience Compassionate Cardiac Care at Avicenna Cardiology

At Avicenna Cardiology, we prioritize your long-term heart health. Whether you’re experiencing symptoms like palpitations, chest pain, or shortness of breath, or seeking a second opinion, our expert cardiologists are here to help.

Visit our convenient NYC locations in Midtown or the Upper East Side for personalized care. Our clinics offer extended hours for your convenience.

Frequently Asked Questions: Heart Failure Cough

The main causes include pulmonary edema, increased blood pressure in the lung arteries (pulmonary hypertension), side effects of certain heart failure medications like ACE inhibitors, and underlying respiratory conditions like COPD or asthma.

A cough accompanied by other heart failure symptoms like shortness of breath, labored breathing, swelling in the legs, fatigue, and weight gain may indicate a cardiac cough. It tends to be persistent for weeks or months, worsen at night/when lying down, and can be wet (expelling phlegm/mucus) or dry.

Yes, the most effective way to manage the heart failure cough is to treat the underlying heart condition itself through medications, procedures, diet, physical activity, and other treatment options aimed at reducing fluid overload and pulmonary congestion.

Diuretics can remove excess fluid from the lungs. Cough suppressants provide temporary relief. Bronchodilators may help if you have concomitant lung diseases. In severe cases with low oxygen levels, supplemental oxygen therapy is beneficial.

Seek prompt medical evaluation if the chronic cough is accompanied by concerning symptoms like severe shortness of breath, coughing up blood, chest pain, fever/chills, whistling sound when breathing, or sudden worsening. These early signs may indicate serious complications.

While common in heart failure, a chronic cough with sudden changes like those above may also potentially signal another underlying condition like an upper respiratory infection rather than just heart disease. Proper evaluation is needed.

In addition to shortness of breath and swelling, the heart failure cough can be accompanied by symptoms like wheezing, fatigue, impaired thinking, heart palpitations, and trouble breathing in severe cases with fluid buildup in the air sacs/lungs.

Yes, avoid triggers like smoke, dust, and strong odors that irritate airways. Stay hydrated to thin out mucus. Use humidifiers/vaporizers to soothe irritated airways. Promptly treating other symptoms may provide relief.

The cardiac cough can significantly diminish the quality of life for those with heart failure. Working closely with a healthcare provider on managing both the cough and underlying condition is crucial for improving overall health outcomes.

About the Author

Azadeh Beheshtian

Azadeh Beheshtian is board certified in cardiovascular disease and internal medicine by the American Board of Internal Medicine. She specializes in interventional cardiology and peripheral artery disease, with a focus on women’s heart health.