Coughing is quite a common condition which is mostly.1 associated with our body trying to get rid of some irritants trapped inside the lungs. Coughing may also be observed during an infection wherein our body is trying to push out the bacteria trapped in the mucus.2
Persistent coughing is mostly caused by long-term diseases of the lungs, such as chronic obstructive pulmonary disease or asthma. Coughing may be reduced by keeping the disease in check with proper treatment. However, if the coughing persists along with some other signs or symptoms, then you may be suffering from congestive heart failure (CHF).2
What is CHF?
Congestive heart failure refers to a state in which your heart muscles are weak or not elastic enough. As a result, the heart is unable to pump enough blood throughout the body.3 CHF occurs when the lower chamber of the heart on the left side is affected. In a healthy heart, this chamber pumps out 50% of the blood it receives during every heartbeat. However, in most patients with CHF, it pumps out less than 40% of the blood that fills it.4
The common causes of CHF include existing health conditions (such as diabetes and high blood pressure) that may affect the heart’s functioning.5,6 It also results from some lifestyle habits such as smoking, consuming foods rich in fat and cholesterol, lack of physical activity and not maintaining a healthy weight.5
Since the heart loses the strength to pump the blood throughout the body, the blood starts backing up in various body tissues. This build-up of fluid in the tissues is the reason this condition is called ‘congestive heart failure’.6
How does CHF cause coughing?
Coughing is a symptom that receives far less attention in heart-related diseases than the more definitive symptoms such as shortness of breath and chest pain.1 CHF results in the build-up of fluids in the lungs, which is a condition known as pulmonary oedema. The body tries and coughs persistently to remove the extra fluids from the lungs.2,8
With appropriate treatment for CHF, the cough should subside. However, if it reappears, then your medicines may need some adjustments.2
Cough induced by medicines for congestive heart failure
Just like the disease causes coughing, the medication used to treat it can also cause similar side effects. Angiotensin-converting enzyme (ACE) inhibitors (such as ramipril) are a common class of medicines prescribed for CHF.9 Unfortunately, ACE inhibitors trigger the development of dry and persistent cough. About 5-35% of the people undergoing treatment with ACE inhibitors reported coughing.10 The only solution to this problem would be to replace ACE inhibitors with another class of medicines.10
Other symptoms commonly associated with CHF are fatigue, limitations in performing normal activities, swelling in the ankles and shortness of breath. These symptoms can be warning signs of CHF and do not necessarily confirm its diagnosis; however, one should not take these symptoms lightly. If you have any such symptoms, a prompt visit to the physician is recommended.11
- Currens JH, White PD. Cough as a symptom of cardiovascular disease. Ann Intern Med. 1949;30(3):528-43. doi: 10.7326/0003-4819-30-3-528.
- Cleveland Clinic. Persistent cough? It may be a sign of heart failure [Internet]. [updated 2018 Dec 28; cited 2019 Dec 9]. Available from: https://health.clevelandclinic.org/persistent-cough-it-may-be-a-sign-of-heart-failure/.
- NCBI. Types of heart failure [Internet]. [updated 2018 Jan 25; cited 2019 Dec 12]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK481485/.
- Cedars Sinai. Heart failure [Internet]. [cited 2019 Dec 09]. Available from: https://www.cedars-sinai.edu/Patients/Health-Conditions/Heart-Failure.aspx.
- American Heart Association. Causes of heart failure [Internet]. [updated 2017 May 31; cited 2019 Dec 09]. Available from: https://www.heart.org/en/health-topics/heart-failure/causes-and-risks-for-heart-failure/causes-of-heart-failure.
- Heart Rhythm Society. Heart failure [Internet]. [cited 2019 Dec 09]. Available from: https://www.hrsonline.org/patient-resources/heart-failure.
- American Heart Association. Warning signs of heart failure [Internet]. [updated 2017 May 31; cited 2019 Dec 9]. Available from: https://www.heart.org/en/health-topics/heart-failure/warning-signs-of-heart-failure.
- American Lung Association. Chronic cough [Internet]. [cited 2019 Dec 9]. Available from: https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/chronic-cough/.
- American Heart Association. Medications used to treat heart failure [Internet]. [updated 2017 May 31; cited 2019 Dec 9]. Available from: https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/medications-used-to-treat-heart-failure.
- Wyskida K, Jura-Szołtys E, Smertka M, Owczarek A, Chudek J. Factors that favor the occurrence of cough in patients treated with ramipril–a pharmacoepidemiological study. Med Sci Monit. 2012 Sep;18(9):PI21-8.
- Harvard Health Publishing. 5 warning signs of early heart failure [Internet]. [updated 2019 Sep 25; cited 2019 Dec 9]. Available from: https://www.health.harvard.edu/heart-health/5-warning-signs-of-early-heart-failure.