Coughing and Heart Failure

Coughing generally is regarded as a symptom of a respiratory infection or an involuntary reaction to swallowing something "wrong," but for people with heart failure a chronic cough can indicate their treatment isn't working as well as it should. A so-called "cardiac cough" or "heart cough" also can be a side effect of certain medications used to treat heart failure—in particular angiotensin-converting enzyme (ACE) inhibitors). If you have heart failure and develop a cardiac cough, it will be important to work with your doctor to figure out what's causing it.

Symptoms of Cardiac Cough

Depending on the cause, coughing and accompanying symptoms caused by heart failure can be experienced in different ways.

• A wet cough producing frothy sputum that may be tinged pink with blood
• Heavy wheezing and labored breathing accompanied by spells of coughing
• A bubbling feeling in the chest or a whistling sound from the lungs
• A flare-up of other heart failure symptoms, including shortness of breath with activity or while lying down, fluid retention, and paroxysmal nocturnal dyspnea (waking up from sleep in the middle of the night, gasping, and coughing)
• A chronic dry cough that may produce a small amount of white or pink frothy mucus
• Coughing at night

Causes

A common aspect of heart failure is that, due to the heart's inefficient pumping ability, blood returning to the heart from the lungs tends to back up, producing congestion in the lungs. This is why people with heart failure are often said to have "congestive heart failure."

With pulmonary congestion, fluid (and even a little blood) can leak into the alveoli (air sacs) of the lungs. This fluid is largely responsible for the shortness of breath commonly experienced by people with heart failure. Because coughing is the body's way of clearing the airway and bronchial passages, coughing can result from pulmonary congestion.

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If despite taking medication for heart failure you develop a chronic cough, it may be an indication your prescription isn't working as effectively as it should to prevent the buildup of fluid in your lungs. It's important to inform your doctor of this problem so that your treatment can be modified.

A dry hacking cough that does not produce sputum is a common side effect of angiotensin-converting enzyme (ACE) inhibitors. Around 4% to 35% of people who take ACE inhibitors develop such a cough. Some people are able to get relief by taking non-steroidal anti inflammatory drugs (NSAIDs), but most ultimately have to discontinue the ACE inhibitor and switch to a different drug—typically an angiotensin II receptor blocker (ARB).

When to See A Doctor

A mild cardiac cough can easily be mistaken for another cause, such as a cold or allergies. However, if you have heart failure, even if you feel positive a virus or allergen is behind your cough, see your doctor. If it turns out your medication isn't working, you may set yourself up for a worsening of your condition.

Similarly, if you suspect your heart medication is to blame for a cough, let your doctor know: Never stop stop taking any medication you have been prescribed, even if you believe it is triggering your cough.

Similarly, do not attempt to self-treat a cough with an over-the-counter cough suppressant or other drug. The active ingredients in some of these—namely pseudoephedrine (Sudafed) and triprolidine-pseudoephedrine (Actifed) can raise blood pressure and cause fluid retention—both side effects that can exacerbate heart failure.