A cough can sometimes be a sign of an underlying heart condition. Coughing is a reflex action to clear irritants or secretions from the lungs and respiratory tract. However, coughs originating from the heart often have a different sound and characteristic than typical coughs. Being able to recognize the signs and symptoms of a cardiac cough can help determine if your cough may be linked to a heart problem.
What is a Cardiac Cough?
A cardiac cough, also sometimes called cardiogenic cough, is a cough that is caused by a heart condition or disease rather than a primary lung condition. It occurs when fluid builds up in or around the lungs due to improper functioning of the heart. This excess fluid in the lungs triggers the cough reflex.
Some of the most common heart problems that can lead to a cardiac cough include:
Heart failure
Heart failure means the heart is not pumping blood efficiently. This causes fluid to back up into the lungs resulting in pulmonary edema (fluid in the lungs). The fluid buildup irritates the lung tissue triggering coughing. Cough from heart failure often worsens when lying down flat or during physical activity.
Cardiomyopathy
Cardiomyopathy refers to diseases of the heart muscle that make it harder for the heart to pump blood. The backup of blood can cause fluid in the lungs, again leading to coughing.
Heart valve disease
Faulty heart valves prevent proper blood flow and allow blood to flow backwards. This backflow can elevate pressure in the lungs and the veins bringing blood back to the heart. The increased pressure pushes fluid out into the lung tissue leading to a cough.
Pulmonary hypertension
Pulmonary hypertension is high blood pressure in the arteries that supply the lungs. It develops when the smaller arterioles become narrowed, twisted, or damaged. This forces the heart to work harder to push blood through the lungs, which increases pressure and fluid leakage.
Coronary artery disease
Coronary artery disease causes the heart’s own blood supply to become reduced or blocked. This can ultimately lead to heart failure with fluid buildup in the lungs. Less common, but blood clots from coronary artery disease can travel to the lung arteries (called pulmonary embolism) which also raise pressures in the lungs that can induce coughing.
Characteristics of a Cardiac Cough
Coughs originating from a heart problem often have distinguishing characteristics compared to coughs from other conditions like infections, asthma, or COPD. Being familiar with the key features of a cardiac cough can help determine when it may be heart related:
Persistent and dry
Cardiac coughs are typically persistent, meaning they last for weeks or months without resolving rather than just a few days. They also tend to be dry, without mucus production. This is because the cause relates to increased fluid leakage rather than airway secretions or inflammation.
Worsens at night
Cough from heart disease tends to become more frequent or severe when lying down flat, especially at night. This is due to the shift of fluid in the body’s gravity when recumbent.
Occurs in episodes
Cardiac coughs often occur in episodes or cycles, meaning coughing that comes and goes in clusters. A cycle may last 5-10 minutes before subsiding again. The coughing bouts are triggered by shifts of fluid in the lungs.
Little relief from cough medications
Typical cough suppressants tend to provide little relief for a cardiac cough. Medications like dextromethorphan or codeine work by reducing airway irritation and secretions, which are not the cause in heart-related coughs.
Associated symptoms
Other concurrent symptoms may provide clues that a cough could be cardiac related. This includes symptoms of heart failure like fatigue, difficulty breathing, weight gain or leg swelling. Heart rhythm disturbances like palpitations may also accompany a cardiogenic cough.
Diagnosing a Cardiac Cough
If a cough has features suspicious for an underlying heart condition, diagnostic testing can help confirm whether heart disease is the culprit:
Physical exam
A physician will listen to the cough and check for signs of heart failure like an S3 heart sound, edema, enlarged liver, or crackles in the lung bases. Irregular heart rhythms may also be detected.
Chest X-ray
A chest x-ray allows visualization of the lungs and heart to look for signs of fluid buildup or heart enlargement that may indicate heart failure. Other lung conditions can also be ruled out.
Blood tests
Blood tests check for an elevated BNP level, which signals heart failure. Kidney function and electrolytes are also assessed.
ECG
An electrocardiogram looks for any heart rhythm abnormalities that could be contributing to coughing episodes.
Echocardiogram
An echocardiogram uses ultrasound imaging to evaluate the heart’s structure and function. It can detect heart failure, valve problems, cardiomyopathy, and high lung pressures.
Cardiac MRI
A cardiac MRI provides a detailed view of the heart to fully evaluate its function and look for underlying problems.
Once a cardiac cause for cough is confirmed, the underlying heart condition can then be treated to alleviate symptoms. Medications, lifestyle changes, or procedures may be used depending on the specific diagnosis. Controlling heart failure or faulty heart valves are key to reducing excess fluid buildup in the lungs that triggers coughing.
Treatment for Cardiac Coughs
The main goal in treating cough from heart disease is to address the underlying cardiac disorder causing the problem. This may include:
Medications
Medications used for treating heart disease like ACE inhibitors, beta blockers, diuretics, or vasodilators can lessen strain on the heart and reduce fluid buildup that leads to coughing. Inhaled bronchodilators may also provide some symptom relief.
Treating heart failure
For cough due to heart failure, medications and lifestyle changes can improve heart function to minimize lung congestion. Things like a low sodium diet, daily exercise, stopping alcohol use, and smoking cessation help manage heart failure.
Surgery
Procedures like valve repair or replacement, coronary bypass, septal defect closure, or implantation of devices to assist heart function may be required depending on the underlying heart abnormality. This treats the source and stops progression of heart disease.
Oxygen therapy
Supplemental oxygen therapy can help reduce coughing from heart disease. Oxygen supports the lungs and heart function when fluid buildup impairs normal oxygen exchange.
Diuretics
Diuretics or “water pills” that increase urination can be used short-term to reduce excess fluid related to heart disease. This directly lowers fluid congestion in the lungs.
Salt restriction
Limiting salt and fluid intake prevents fluid retention that can worsen cough from heart failure. Sticking to a low-sodium diet helps minimize fluctuations in lung congestion.
While troubling, a cough caused by an underlying heart problem can often be managed and relieved by taking steps to improve the cardiac condition. Paying attention to the characteristics and triggers of your cough may provide the clue to seek appropriate heart evaluation and treatment if a cardiac cause is suspected. Ongoing follow up with your cardiologist is key to keep heart disease controlled and prevent recurrence of symptoms like coughing.
When to See a Doctor
You should see a doctor promptly if you have any of the following:
– A cough that persists longer than 3 weeks
– Episodes of severe coughing at night
– A cough that produces pink, frothy sputum
– Worsening shortness of breath with exertion or at rest
– Swelling in the legs
– Dizziness or fainting
These signs can indicate a growing heart problem that requires further evaluation.Sudden onset of coughing with chest pain and trouble breathing could mean a pulmonary embolism, which is a medical emergency.
It’s important not to assume that a nagging cough is just a simple irritation. See your doctor to determine the cause and rule out conditions like heart disease, lung disease, reflux, or medication side effects. Proper treatment depends on an accurate diagnosis.
When to Call 911
Call 911 or emergency medical services if you experience:
– Severe sudden chest pain
– Shortness of breath at rest
– Coughing up blood
– Irregular heartbeat with dizziness or passing out
These symptoms suggest a potentially life-threatening heart problem that requires immediate emergency care, such as a heart attack, cardiac arrest, or pulmonary embolism. Waiting to call for an ambulance can delay treatment and puts your health and life at risk.
Prevention of Cardiac Cough
You can reduce your risk of developing cardiac coughs by taking these preventive measures:
Control blood pressure
High blood pressure damages the heart over time and can lead to cough-causing conditions like heart failure. Keep blood pressure optimized.
Lower cholesterol
High cholesterol causes coronary artery disease. Statin medications and diet changes can improve cholesterol levels.
Maintain healthy weight
Obesity strains the heart and contributes to problems like cardiomyopathy and valve dysfunction.
Limit alcohol
Chronic heavy alcohol use directly weakens the heart muscle leading to dysfunction and failure.
Don’t smoke
Smoking considerably worsens heart disease and lung problems that provoke coughing. Quit smoking to reduce risk.
Manage diabetes
Poorly controlled diabetes causes cardiovascular damage. Keep blood sugars regulated.
Exercise regularly
Physical activity conditions the heart, helps control weight, and lowers cardiac risk factors.
Lower stress
High stress aggravates factors like blood pressure and inflammation that accelerate heart disease development.
Gaining control over these modifiable risks gives you the power to reduce your chances of a cardiac cough down the road.
Conclusion
While most coughs are caused by relatively benign conditions, sometimes a cough can stem from an underlying heart problem. Cardiac coughs result from excess fluid accumulation in or around the lungs due to improper functioning of the heart. They have distinguishing characteristics like being persistent, non-productive, worse at night, and resistant to cough medications. A cardiac cough may signal heart failure, pulmonary hypertension, faulty heart valves, or cardiomyopathy. Diagnostic tests like echocardiograms, ECG, x-rays, and bloodwork help confirm heart disease as the source. By treating the causative heart disorder with medications, surgery, or lifestyle changes, cardiac coughs can often be well managed. Being alert to symptoms warrants seeing your doctor to determine if your cough could be related to heart disease rather than overlooking a serious health problem. Addressing heart health is key for both resolving coughs and improving your overall wellbeing.