What to know about congestive heart failure and coughing

In many cases, coughing is a symptom of congestive heart failure. Doctors sometimes refer to this as a cardiac cough.

A cough that occurs as a symptom of heart failure is usually persistent and produces white or pink blood-tinged mucus. However, if the cough results from a medication for heart failure, it may sound dry.

People living with heart failure may also experience wheezing — labored breathing or a whistling sound in the lungs — that worsens when they are lying down.

Coughing due to congestive heart failure may mean the heart condition is becoming worse. According to a 2017 study, lung congestion is the primary cause of hospitalization in people with heart failure.

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A cardiac cough involves coughing that develops as a result of heart issues, not lung conditions. A few factors can lead to a cardiac cough, which we explore in more detail below.

Fluid retention

When a person has heart failure, the heart cannot pump enough blood throughout the body, and this causes fluid retention. Fluid can build up in the air sacs in the lungs. Healthcare professionals refer to this as lung congestion, or pulmonary edema.

When fluid retention occurs in the lungs, the body attempts to clear the lungs, which causes coughing. Various factors may influence the development of fluid in the lungs, including diet and the severity of heart failure.

Cardiac medication side effects

Medications to treat heart failure may improve heart function, but they can cause side effects. Coughing is one possible side effect of certain cardiac medications.

For example, healthcare professionals often prescribe angiotensin-converting enzyme inhibitors (ACE inhibitors) to treat congestive heart failure. ACE inhibitors can trigger a chronic dry cough.

The incidence of coughing as a side effect is anywhere from 3.9–35%. However, this varies depending on the specific type of ACE inhibitor.

A cough due to medication side effects may develop as soon as a few hours after a person takes the first dose or as late as months afterward.

When the heart does not pump blood effectively, it may cause several symptoms throughout the body. The severity of symptoms may depend on the stage of heart failure.

According to the American Heart Association, in addition to coughing, possible symptoms of congestive heart failure include:

• shortness of breath
• fluid buildup in the body, including swelling in the legs
• persistent fatigue that causes difficulty with daily activities such as walking and climbing stairs
• exercise intolerance
• loss of appetite
• nausea
• increased heart rate
• confusion

Treatment for coughing due to congestive heart failure involves decreasing the excess fluid in the lungs and treating underlying heart function issues.

We discuss treatment options in more detail below.

Medication

Doctors often prescribe diuretics, which reduce fluid retention in the lungs and other body areas. Decreasing fluid buildup can alleviate coughing.

People with congestive heart failure may also receive medication to improve heart function. These medications may reduce the heart rate, improve blood pressure, and help the heart beat more efficiently.

Examples include:

• ACE inhibitors
• angiotensin receptor blockers
• ARNIs
• beta-blockers
• aldosterone agonists
• SGLT2 inhibitors

If ACE inhibitors are causing a cough, healthcare professionals may recommend that a person switch to angiotensin receptor blockers.

Learn more about medication for heart failure.

Home management

Lifestyle modifications may help reduce symptoms of heart failure.

A healthcare professional may advise a person to track and limit their daily liquid intake to decrease fluid buildup, which may reduce coughing.

People with congestive heart failure can take other steps to manage their condition, such as:

• reducing salt intake
• limiting caffeine
• quitting smoking
• limiting alcohol consumption
• exercising regularly

Anyone with symptoms of congestive heart failure should contact a healthcare professional. Individuals with congestive heart failure require a treatment plan to decrease symptoms and slow the progression of the condition.

People who have a diagnosis of congestive heart failure should contact a healthcare professional if they:

• experience swelling in the ankles, feet, or legs
• cough up blood or pink-tinged mucus
• gain more than 3 pounds in 24 hours, which may signal fluid retention
• have increased shortness of breath or exercise intolerance

A person should seek emergency treatment if the following symptoms develop:

• chest pain
• extreme shortness of breath
• confusion
• bluish skin

Here are some answers to frequently asked questions about heart failure and coughing.

What does a congestive heart failure cough sound like?

A cough due to congestive heart fluid often sounds “wet.” Healthcare professionals describe a wet cough as one that produces rales, or crackles, when they listen to it with a stethoscope. Crackles sound like rattling or popping.

A person may also experience wheezing, which can sound like a whistling noise in their lungs.

How do I know if my cough is heart-related?

Individuals may not know whether their cough is heart-related unless they have certain diagnostic tests. A heart-related cough can have similar symptoms to certain lung diseases.

Congestive heart failure occurs when the heart cannot pump enough blood throughout the body to meet demands. This may cause a buildup of fluid in the body, including in the lungs.

Coughing develops as a reaction to irritation from excess fluid in the lungs. Treatment includes medication to improve heart function and decrease fluid retention.