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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