Here’s What You Need To Know About Coughing and Heart Failure

There are several reasons you might have a cough that doesn’t go away, from respiratory infections and allergies to lung conditions, like asthma or COPD. But what if being treated for these conditions isn’t bringing relief?

It may be time to get evaluated by a cardiologist. They can figure out if heart failure or another type of heart disease is causing your chronic cough.

Cardiologist and heart failure specialist Michael Hill, MD, explains the connection between cough and cardiac disease, how to tell if you have a heart cough and when to get help.

The connection between a cough and heart problems

Many heart problems can trigger a chronic cough caused by fluid building up and getting trapped in your lungs (pulmonary edema). Your body makes you cough — and cough, and cough — in an effort to clear it.

If you’re not being treated for the underlying problem, your “heart cough” will stick around, no matter how many medications your provider throws at it.

“Many people with a chronic cough may think it’s connected to a virus, like a cold or flu, a medication side effect or a lung problem,” Dr. Hill says. “These are important causes to look for, but heart failure may enter the conversation when the symptoms don’t improve with appropriate treatment.”

Many heart conditions can cause a “cardiac cough.” If other, less serious causes (like postnasal drip or acid reflux) have already been ruled out, your provider will run tests to determine whether you have heart failure or another condition that affects your heart, such as:

• Mitral valve disease
• Pulmonary hypertension
• Pericardial effusion
• Irregular heart rhythm (arrhythmia)
• Frequent palpitations (PVCs)

How to know if you have a cardiac cough

While you need to see a doctor to confirm, you can often tell a heart cough from a regular cough by its characteristics. A congestive heart failure cough:

• Can become worse when lying down or while asleep
• Can be either dry and hacking or bring up frothy mucus
• Can come with other symptoms, like shortness of breath with activity, weight gain or swelling

A bad cough rarely happens in isolation. Examining your other symptoms can help you figure out if your cough could be linked to an underlying heart issue.

“When someone tells me about rapid weight gain, swelling in their legs or belly, and shortness of breath, heart failure is a real possibility,” Dr. Hill says. “Even vague symptoms of fatigue, nausea, appetite loss or getting full quickly can be early signs.”

He also notes that some heart medications can lead to a chronic cough. Lisinopril and enalapril, both common blood pressure medications, are good examples. If you’re on these medicines, ask your doctor if they could be causing your symptoms.

In addition to those symptoms, Dr. Hill advises seeking an evaluation if:

• You’re wheezing.
• There’s a bubbling feeling in your chest.
• Shortness of breath worsens when you exercise or lie down.
• You’re working hard to breathe (and your chest muscles are sore).
• There’s a whistling sound coming from your lungs.
• You wake up dizzy.

When to seek care

If traditional cough remedies aren’t working, it’s important to talk to your primary care physician.

“It’s important to check in with your doctor if your symptoms aren’t improving with treatment,” Dr. Hill reiterates. “If the cause still isn’t clear, consider asking for a referral to a cardiologist or pulmonologist.”

Whether you see a lung doctor or a heart doctor, chances are, they’re going to run tests to see what’s causing your cough.

“When heart failure is the cause, starting the appropriate medications should make the cough improve or go away,” he adds. “If it returns, your medications may need to be changed or adjusted.”

Final thoughts on coughing and heart problems

It’s easy to tell someone to see their doctor. But it can be much harder to actually do it when you’re worried. What if something really is wrong with your heart? What then?

“The term ‘heart failure’ is understandably scary and can make people feel like there is no hope,” Dr. Hill recognizes. But he explains that, at the most basic level, heart failure describes any situation where the heart isn’t pumping enough blood to the body or pumping out all the blood it receives.

It can happen for many reasons, like weakness or stiffness of the heart muscle, valve disease, abnormal heart rhythms and more.

“With the right medications and procedures, we can often address the root cause of the problem, and people can go on to live happy, active and full lives,” he reassures.

Being proactive is one of the keys to heart health. The sooner you know what’s causing your symptoms, the sooner you can get the treatment you need, make any lifestyle changes and reach out to your loved ones for support.