Although it sounds total and catastrophic -- like a power failure -- "heart failure" doesn't mean that the heart just stops (that's "cardiac arrest"). Heart failure is marked by a drop in the heart's pumping ability: It just doesn't do as good a job at pumping the blood, and one common result is lung congestion.
Since coughing is the body's way of clearing the airway and bronchial passages, it makes sense that it's a prominent symptom of heart failure. In fact, an older term for the condition is "congestive heart failure."
Heart failure occurs most frequently in those over 65 years of age, and it results in the hospitalization of more than a million Americans each year. It has many causes, including high blood pressure, prior heart attack or another form of heart disease and -- in addition to lung congestion -- it is often characterized by swelling, for example, of the legs, feet or abdomen.
The coughing of heart failure can take several forms. A wet, frothy cough that can be tinged pink with blood is very common. So is a dry, hacking cough that doesn't expel mucous. Patients may waken in the middle of the night gasping and coughing. As a result, many prefer to sleep propped up in a semi-reclined position. Heavy wheezing and labored breathing can also accompany coughing spells, and patients may experience a bubbling feeling or whistling sound in their lungs.
Ironically, coughing is also frequently a side effect of a type of medication that's frequently prescribed for heart failure: angiotensin-converting enzyme (ACE) inhibitors, which are also used to treat high blood pressure and other cardiac conditions. They work by dilating the arteries, easing blood flow and decreasing the heart's workload. This class of medications also acts as a diuretic, increasing urine flow and reducing excess fluid that could otherwise contribute to congestion and swelling.
However, many patients who take ACE inhibitors complain of a dry cough and ask to discontinue the medication. In the early 2000s, scientists found that taking an iron supplement helps mitigate this medication-induced coughing because it curbs the production of nitric oxide, which can irritate bronchial passages in the lungs.
Another option for addressing an ACE inhibitor-related cough is switching to an angiotensin II receptor blocker (ARB), which has many of the same advantages as the ACE inhibitor, but the ARB doesn't trigger bothersome coughing. However, because fewer clinical studies have been completed on ARBs, they aren't prescribed as often as ACE inhibitors.
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