Heart Failure and Cough: What’s the Connection?

Why a Cough May Be an Important Sign of Heart Failure

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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.

Symptoms of Cardiac Cough

Verywell / Laura Porter

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:

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:

Heart Failure Healthcare Provider Discussion Guide

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

Doctor Discussion Guide

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.

When to Call 911

If you have CHF, call 911 or seek emergency medical assistance if:

  • You cannot breathe when lying down.
  • You feel as if you are suffocating.
  • You have chest pain, rapid heartbeat, or shortness of breath that does not go away with rest.
  • You have fainted or lost consciousness.


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.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Heart Association. Warning signs of heart failure.

  2. Abassi Z, Khoury EE, KarramT, Aronson D. Edema formation in congestive heart failure and the underlying mechanisms. Front Cardiovasc Med. 2022 Sep 27;9:933215. doi:10.3389/fcvm.2022.933215

  3. Yılmaz İ. Angiotensin-converting enzyme inhibitors induce cough. Turk Thorac J. 2019;20(1):36-42. doi:10.5152/TurkThoracJ.2018.18014

  4. Forfia PR, Vaidya A, Wiegers SE. Pulmonary heart disease: the heart-lung interaction and its impact on patient phenotypes. Pulm Circ. 2013 Jan-Mar;3(1):5–19. doi:10.4103/2045-8932.109910

  5. National Institutes of Health. Cor pulmonale.

  6. American Heart Association. Managing heart failure symptoms.

  7. American Heart Association. Taking medicine for a cold? Be mindful of your heart.

By Richard N. Fogoros, MD
Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology.