A heart failure cough is a common symptom of heart failure, which occurs when the heart is too weak to pump enough blood to meet the body’s needs. A cough caused by heart failure often feels different from a normal cough and has some distinctive characteristics. Understanding what a heart failure cough feels like can help identify when someone may be experiencing heart failure.
What is heart failure?
Heart failure refers to a chronic condition where the heart cannot pump sufficient blood to meet the body’s demands. It usually develops gradually over time as the heart’s pumping power declines. The most common causes are:
- Coronary artery disease – narrowing of the arteries supplying blood to the heart muscle
- High blood pressure – which forces the heart to work harder
- Heart attack – damage to the heart muscle
- Cardiomyopathy – diseases of the heart muscle
- Congenital heart defects – abnormalities in heart structure present at birth
- Diabetes – which can damage blood vessels and nerves that support the heart
As the heart’s pumping ability decreases, blood often backs up in the lungs and causes fluid build-up. This is called congestive heart failure. The fluid in the lungs (pulmonary congestion) interferes with normal breathing and oxygen exchange.
What causes the cough?
In heart failure, excess fluid can accumulate in and around the lungs. This fluid puts pressure on the lungs and airways, triggering nerves that provoke coughing. Additionally, the buildup of fluid hampers gaseous exchange, limiting oxygen absorption and carbon dioxide removal. The cough reflex activates to try to clear out the congestion and reopen the airways.
Some other potential causes of coughing in heart failure include:
- Pulmonary edema – fluid leaking from blood vessels into lung tissues
- Pleural effusion – fluid accumulation between the lung and chest cavity
- Postnasal drip – excess mucus dripping down the throat from the sinuses
- GERD – gastric reflux pushing stomach acid up into the esophagus
Coughing serves as a protective mechanism to clear irritants or secretions from the lungs and keep the airways open. However, in heart failure the cough is also a symptom of the underlying problem with excess fluid congestion.
What does a heart failure cough feel like?
Some of the main characteristics of a cough caused by heart failure include:
- Wet/moist – cough sounds moist or wet rather than dry. This is from excess mucus or fluid in the lungs.
- Hacking – short, coarse bursts of coughing. The cough is abrupt and hacking, compared to soft and gentle.
- Barking – cough has a rough, coarse, or hoarse sound.
- Noisy – loud cough that can be disruptive.
- Persistent – cough lasts a long time and keeps recurring.
- Worse at night – cough often gets worse when lying down at night.
- Triggered by activity – cough flares up during physical activity or exertion.
A heart failure cough may produce significant mucus or even pink, frothy sputum tinged with blood (pulmonary edema). The wetness and congestion can create bubbling or gurgling sounds. Coughing fits can last for prolonged periods and cause gagging or vomiting. Unlike a normal dry cough, it does not improve with cough medicine.
What are the impacts of a chronic cough?
A persistent cough caused by heart failure can have many adverse effects, including:
- Fatigue – from constant coughing and interrupted sleep.
- Insomnia – cough keeps the person awake at night.
- Shortness of breath – coughing worsens existing breathing difficulties.
- Chest discomfort – from coughing fits and irritation.
- Headaches – from pressure changes in the chest and head.
- Dizziness – from lack of oxygen and drops in blood pressure.
- Nausea – gagging from coughing can trigger vomiting.
- Sore throat – from irritated throat tissues.
- Muscle strain – from the strong contractions during coughs.
- Lightheadedness or fainting – from cough syncope when blood pressure drops.
- Mood changes – anxiety, depression, and irritability.
The impacts on sleep, breathing, and oxygenation levels can significantly reduce quality of life. Coughing can worsen the underlying heart failure by increasing pressure in the chest.
When to see a doctor
It’s important to consult a doctor if you experience any of the following:
- Cough lasting longer than 3 weeks
- Cough that produces blood or yellow/green mucus
- Wheezing or difficulty breathing with cough
- Unexplained weight loss
- Fever, chills, or night sweats
- Facial or neck swelling
- Exposure to people with tuberculosis
A chronic cough may be a sign of an underlying health condition requiring treatment. Heart failure requires prompt medical care to relieve symptoms and prevent complications.
Diagnosing a heart failure cough
Doctors can use various tests to evaluate an unexplained chronic cough and check for heart failure:
- Medical history – asking about cough characteristics, associated symptoms, and risk factors.
- Physical exam – listening to the heart and lungs for abnormalities.
- Chest X-ray – identifying lung congestion or enlargement of the heart.
- Sputum test – examining mucus under a microscope for bacteria, fungi, or cancer cells.
- Lung function tests – measuring how well the lungs exhale and inhale air.
- Echocardiogram – using ultrasound to visualize the heart’s structure and pumping function.
- Blood tests – checking oxygen and carbon dioxide levels.
These tests can detect signs of heart failure like fluid in the lungs, impaired pumping ability, or reduced blood oxygenation.
Treating a heart failure cough
Treatment focuses on the underlying heart failure to reduce fluid buildup and congestion in the lungs. Options may include:
- Medications – such as diuretics, ACE inhibitors, beta blockers, or inotropes.
- Cutting salt intake – to decrease fluid retention exacerbating the congestion.
- Oxygen therapy – to improve oxygen levels.
- Treating accompanying conditions – such as anemia or kidney disease.
- Surgery – to repair heart valves or unclog blockages.
- Medical devices – like ventricular assist devices or implanted defibrillators.
- Lifestyle changes – avoiding smoking, losing weight, and exercising.
The cough should improve as the excess fluid buildup is reduced and heart function improves. Quick-relief cough medications are generally ineffective for a heart failure cough.
Home care strategies
Some self-care tips for managing a heart failure cough at home include:
- Use a humidifier to moisten dry irritated airways.
- Drink plenty of fluids to thin out mucus.
- Use cough drops or hard candy to coat the throat.
- Breathe moist air from a hot shower.
- Sleep propped up with pillows to ease nighttime coughing.
- Avoid irritants like smoke, dust, and chemicals.
- Try honey or herbal teas to soothe the throat.
- Use chest percussion to loosen mucus.
- Try relaxation techniques like meditation to suppress the cough reflex.
See a doctor if symptoms persist despite home care or start to worsen. Worsening cough with greater difficulty breathing may indicate acute heart failure requiring prompt medical intervention.
Prognosis
With treatment, the outlook for heart failure cough depends greatly on the individual’s underlying heart condition. Mild cases can resolve quickly with diuretics to reduce fluid overload. But severe long-term heart failure may require intensive medication and lifestyle management to control symptoms.
Poorly controlled congestive heart failure has a poor prognosis, with roughly 50% mortality within 5 years. Aggressive treatment to restore heart function and prevent fluid buildup in the lungs is essential.
Prevention
Steps to help prevent heart failure and associated coughing include:
- Controlling high blood pressure.
- Lowering cholesterol levels.
- Preventing or managing heart disease and diabetes.
- Avoiding smoking and excess alcohol.
- Maintaining a healthy weight.
- Exercising regularly.
- Restricting salt to avoid fluid overload.
- Managing stress.
- Getting regular check-ups.
Conclusion
A heart failure cough has distinct characteristics including being wet, noisy, persistent, and worse at night. The cough is caused by fluid buildup in and around the lungs due to inadequate heart pumping. Treatment focuses on improving heart function and reducing congestion. While cough medication does not help, home care strategies can provide some relief. Preventing heart failure through healthy lifestyle choices gives the best protection against developing this type of chronic cough.
