Can a Cough Be Related to Heart Issues?

When something is irritating our lungs, or our body is trying to get rid of bacteria trapped in mucus, we understand the coughing will stop as soon as the irritant or infection is gone.

A persistent cough is another matter, though. The most common causes of a persistent cough are asthma or chronic obstructive pulmonary disease (COPD). But even with these diseases, coughing is minimized when inflammation in your lungs is kept under control.

That’s why if you’ve been diagnosed with asthma or bronchitis, and your cough doesn’t improve with treatment, you should be evaluated for heart failure.

“I have met patients who were first diagnosed as having a respiratory issue,” says heart failure specialist Miriam Jacob, MD. “Over time, when their symptoms didn’t improve with appropriate treatment, heart failure was entertained as a diagnosis.”

Dr. Jacob discusses what a heart cough is and how it’s treated.

What is a heart cough?

In heart failure, your heart muscle has dysfunction that might be due to weak contraction or stiffness. This can allow fluid to back up in your lungs, creating a condition called pulmonary edema. Your body coughs persistently in an effort to eliminate the excess fluid.

Symptoms can include:

• Shortness of breath that worsens with exercise or while lying down.
• Heavy wheezing.
• A bubbling feeling in your chest.
• A wet cough with white or pink sputum, or mucus.
• A dry cough.

“I’ve had patients who come to me after months of being treated with antibiotics or steroids for a persistent cough,” says Dr. Jacob. “Understandably, their physicians treated common medical problems like an upper respiratory infection. When a patient also tells me about weight gain, swelling in the legs or belly and shortness of breath I am suspicious of heart failure. Even vague symptoms of fatigue, nausea or getting full quickly can be signs of heart failure.”

How is a heart cough treated?

If you’re experiencing symptoms, it’s important to talk to your doctor. After an exam, your doctor may want to run tests. These can include a blood test, chest X-ray, echocardiogram, electrocardiogram (EKG) stress test, heart catheterization or cardiac MRI.

After determining the type, class and severity of your heart failure, your doctor may recommend certain lifestyle changes, like:

• Eating a heart-healthy diet.
• Maintaining or losing weight.
• Exercising.
• Managing stress.
• Avoiding or limiting alcohol and caffeine.
• Quitting smoking.

There are many medications available to treat heart failure. Your doctor may recommend:

• Angiotensin-converting enzyme (ACE) inhibitors.
• Angiotensin II receptor blockers.
• Angiotensin-receptor neprilysin inhibitors.
• Beta-blockers.
• Aldosterone antagonists.
• Digoxin
• Diuretics.
• Hydralazine and isosorbide mononitrate.
• SGLT2 inhibitors.

“Once heart failure has been diagnosed and appropriate treatment started, the cough should improve or go away,” assures Dr. Jacob. “If it returns, your medications may need adjusting or your angiotensin-converting enzyme inhibitor changed to an angiotensin receptor blocker.”

Is all coughing a sign of heart failure?

No. There’s a host of reasons you may have a cough.

Irritants or allergens like smoke, mold, dust and pollen can cause you to cough. Certain medical conditions like a cold, flu, pneumonia, acid reflux and sinusitis can also make you cough.

But if you’re experiencing heart cough symptoms or have been diagnosed with asthma or bronchitis and your cough doesn’t improve with treatment, you should talk to your doctor about heart failure.

“It’s important to check in with your doctor if your symptoms of cough aren’t improving after the treatment you’ve been recommended,” says Dr. Jacob. “You should be your own advocate. If you feel that you continue to have a cough that isn’t resolving you could ask to be referred to a pulmonologist or cardiologist to get another opinion.”