A Symptom of Heart Failure May Be Coughing
Most people assume that coughing is
associated with a lung or an airway problem. But, an unusual suspect may
actually be the heart. It isn't unusual for people who have heart
failure to experience significant coughing. In fact, a cough may
indicate an important sign that heart failure treatment is inadequate,
or, possibly, treatment may be causing problems.
1. Heart Failure
Heart failure does not mean that the heart just stops, that is cardiac
arrest. Rather, it means that the heart's pumping ability has been
impaired to the extent that the heart is not always able to keep up with
the demands of the body. Heart failure can cause a number of cardiac
disorders, including coronary artery disease, hypertension, hypertrophic
cardiomyopathy, diastolic dysfunction, and heart valve disease, among
several others. Heart failure is a common disorder, with over a million
people each year being hospitalized in the U.S.
A common problem with 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 pulmonary congestion,
which is why people with heart failure are often said to have
'congestive heart failure.'
Consequently, with pulmonary congestion, fluid, and a little blood, can
leak into the alveoli (air sacs) of the lungs. This lung fluid is what's
largely responsible for the dyspnea (a feeling one cannot breathe
properly) commonly experienced by people with heart failure because
coughing is the body's way of clearing the airway and bronchial
passages. Thus, it makes sense that a cough can also result from
pulmonary congestion.
2. Cardiac Cough
Coughing caused solely by heart failure can take several forms. A wet
cough produces frothy sputum that may be tinged pink with blood, tends
to be quite common with heart failure. Heavy wheezing and labored
breathing may also accompany spells of coughing, along with a bubbling
feeling in the chest, or even a whistling sound from the lungs.
Coughing symptoms like this usually are a sign that heart failure has
become substantially worse, and such a cough is usually accompanied by a
general flare-up of heart failure symptoms. These symptoms are likely
to include dyspnea, orthopnea (shortness of breath when lying down),
edema (swelling), and paroxysmal nocturnal dyspnea - waking up from
sleep in the middle of the night, gasping and coughing. However, people
who have this severe form of cardiac cough are generally sick enough to
seek medical help without much prompting.
A cardiac cough can take a much less severe form. Some people with heart
failure will develop an annoying, more chronic, drier cough that may
produce a small amount of white or pink frothy mucus. People who have
this less severe form may assume it to be due to some other cause, and
thus may fail to seek medical assistance. In doing so, however, the
symptoms of heart failure are likely to become substantially worse. So
anyone who has been told they have heart failure should not ignore the
onset of a cough even if they consider it to be mild.
3. Medication-Related Cough
Coughing is also a common effect of a class of medication that is often
prescribed to those who have been diagnosed with heart failure:
angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors are
helpful for heart failure because they dilate the arteries, thus making
it easier for the heart to pump blood. These drugs, however, produce a
cough in about 4% of people who do take them.
The cough they experience is generally a dry hacking cough which does
not produce sputum.
Reports suggest that non-steroidal anti-inflammatory
drugs (NSAIDs) may improve a cough caused by ACE inhibitors, but, in
the large majority of people who have this problem, the drug must be
discontinued, primarily because the ACE inhibitor can be switched to an
angiotensin II receptor blocker (ARB), which has many of the same
advantages as the ACE inhibitor, but which causes coughing less
frequently. A change in medication can help relieve a dry, hacking cough
due to ACE inhibitors.
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