Heart Failure and Cough: What’s the Connection?

A persistent cough in someone with congestive heart failure may be a sign of a potentially serious health concern. In some cases, a heart failure cough (sometimes referred to as a "cardiac cough") may be a sign that your condition is worsening or your medications aren't working as well as they should.

This article looks at the symptoms and causes of a cardiac cough, including when it is time to see a healthcare provider.

What Are the Symptoms of a Cardiac Cough?

The symptoms of a cardiac cough vary depending on the underly cause. Even so, there are characteristic signs and symptoms to watch out for.

These include:

• A persistent cough with pink, frothy sputum (hemoptysis)
• Shortness of breath (dyspnea)
• Wheezing breaths
• Rapid, shallow breathing (tachypnea)
• Difficulty breathing when lying down (orthopnea)
• Crackling sounds in the lungs (rales)
• Nighttime awakenings with a drowning sensation (paroxysmal nocturnal dyspnea)

You may experience other symptoms of heart failure as well, including chronic fatigue, rapid or irregular heartbeats, and swelling of the feet and ankles.

Causes of Cardiac Coughing

Congestive heart failure (CHF) is when the heart is less able to pump blood efficiently to meet the body's needs. When this happens, blood and fluids start to back up and collect in the lungs and legs.

The buildup of fluids in the lungs can lead to a serious medical condition known as pulmonary edema. One of the early signs of pulmonary edema is a persistent cough.

In people with CHF, a cardiac cough may be a sign of different things, including:

• Worsening heart failure
• Undertreatment of CHF
• Inconsistent dosing of CHF medications, including missed doses

The cough may also be a side effect of angiotensin-converting enzyme (ACE) inhibitors commonly prescribed to people with CHF. However, ACE inhibitors cause a dry, hacking cough unlike the wet productive cough associated with pulmonary edema.

Heart Failure and Lung Disease

Sometimes a cough is mistaken for a lung disease when it is actually a heart problem triggered by a lung disease. This is referred to as chronic pulmonary heart disease (PFD).

Pulmonary heart disease happens when the chamber of the heart that pumps blood to the lungs (called the right ventricle) has to work too hard and incurs damage over time. When the right ventricle fails, it is called cor pulmonale.

Cor pulmonale (also known as right-sided heart failure) is a serious medical condition that is always caused by lung disease. Symptoms can develop slowly or suddenly but typically include:

• Chronic productive cough
• Wheezing
• Shortness of breath
  
• General fatigue
• Extreme exhaustion with minimal exercise
• General fatigue
• Dizziness
• Swelling of the feet and ankles

Possible causes of cor pulmonale include:

• Chronic obstructive pulmonary disease (COPD): An obstructive, inflammatory lung disease
• Pulmonary hypertension: High blood pressure in the arteries of the lungs
• Autoimmune diseases: Including lupus and scleroderma directly damage the lungs
• Cystic fibrosis (CF): A progressive genetic disease that affects the lung and other organs
• Bronchiectasis: The progressive, irreversible widening of the airways
• Interstitial lung disease (ILD): A large group of diseases that cause scarring of the lungs
• Obstructive sleep apnea (OSA): A chronic condition where breathing slows or stops during sleep
  

Heart Failure Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

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When to See a Healthcare Provider

If you have CHF, it is important to call your healthcare provider if:

• You develop a persistent cough for no known reason.
• You start coughing soon after a change in your treatment.
• Your coughing is accompanied by other symptoms such as chest pain, irregular heartbeats, swelling of the ankles and feet, or an overnight weight gain of 2 to 3 pounds (or 5 pounds in a week).

Be advised that over-the-counter decongestants containing pseudoephedrine and phenylephrine can raise your blood pressure and worsen the symptoms of heart failure. If you have CHF, these should only be used under the direction of a healthcare provider.

Summary

A cardiac cough can develop if you have heart failure as fluids build up in the lungs. This may be due to worsening heart failure or because your drugs are not working as well as they should. It could also be that you're not taking your medications as prescribed or that you're experiencing side effects from ACE inhibitors.

Call your healthcare provider if you have heart failure and develop a persistent cough for no apparent reason. This is true if a chronic cough is your only symptom or if it occurs with other signs and symptoms of heart failure.