Congestive Heart Failure and Cough

Introduction

Cough is a common but often overlooked symptom in patients with congestive heart failure (CHF). It can be due to fluid buildup in the lungs, a side effect of medications, or other underlying conditions. Understanding the relationship between CHF and cough can help manage the symptom effectively.

Why Does CHF Cause Cough?

1. Pulmonary Congestion

• In CHF, the heart's pumping ability is weakened, leading to fluid accumulation in the lungs (pulmonary congestion).
• This fluid irritates the airways, triggering a persistent, wet or dry cough.

2. Side Effects of Medications

• Some medications used to treat heart failure, notably ACE inhibitors (e.g., Lisinopril, Enalapril), can cause a dry, persistent cough in some patients.
• This side effect affects around 5–20% of patients and is due to the accumulation of bradykinin, a substance that irritates the airway.

3. Lung Conditions Associated with CHF

• Patients with CHF may develop pulmonary edema (fluid in the lungs) or chronic lung diseases like chronic obstructive pulmonary disease (COPD), which contribute to coughing.

Symptoms Associated with a CHF-Related Cough

• Persistent cough (wet or dry)
• Coughing more at night (due to fluid redistribution when lying down)
• Shortness of breath (dyspnea)
• Frothy, pink-tinged sputum (a sign of severe pulmonary congestion)
• Fatigue and swelling in the legs (other signs of CHF)

How to Manage CHF-Related Cough

1. Medication Adjustments

• If ACE inhibitors cause coughing, switching to an angiotensin receptor blocker (ARB) like Losartan or Valsartan may help.

2. Diuretics to Reduce Lung Fluid

• Diuretics (e.g., Furosemide) help the body eliminate excess fluid, reducing lung congestion and improving symptoms.

3. Lifestyle Changes

• Limit salt intake to reduce fluid retention.
• Elevate the head while sleeping to ease breathing.
• Manage underlying lung diseases like COPD or asthma appropriately.

4. When to See a Doctor

• If you have severe shortness of breath, a worsening cough, or pink frothy sputum, seek medical help immediately, as these could indicate acute pulmonary edema, a life-threatening emergency.

Conclusion

A cough in CHF can be due to fluid buildup, medication side effects, or coexisting lung conditions. Proper medication adjustments, fluid management, and lifestyle changes can help control this symptom. Always consult with a healthcare provider if cough worsens or new symptoms appear.

Source recommendations

1. European Society of Cardiology (ESC) Guidelines on Heart Failure

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
2. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Focused-Update-on-Heart-Failure-Guidelines
4. https://academic.oup.com/eurheartj/article/44/37/3627/7246292
5. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines

2. American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines on Heart Failure Management

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
2. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/03/29/19/53/2022-AHA-ACC-HFSA-Heart-Failure-Guideline-gl-hf
3. https://pubmed.ncbi.nlm.nih.gov/35363499/
4. https://professional.heart.org/en/science-news/-/media/832EA0F4E73948848612F228F7FA2D35.ashx
5. https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/classes-of-heart-failure

3. European Respiratory Society (ERS) Guidelines on Chronic Cough

1. https://publications.ersnet.org/content/erj/55/1/1901136
2. https://pubmed.ncbi.nlm.nih.gov/31515408/
3. https://publications.ersnet.org/content/erj/29/6/1256
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC6942543/
5. https://publications.ersnet.org/content/erjor/early/2024/06/27/2312054100459-2024