Heart failure cough: a symptom that needs attention
The content of the article:
- Development mechanism
- Cough characteristic
- Associated symptoms
- Distinctive signs of cough in other diseases
- Research Supporting Cardiac Coughing
- Treatment tactics
- Video
Heart failure cough is not a specific symptom of the disease. Its appearance indicates an increase in pressure in the pulmonary circulation.
In heart failure, coughing does not function as a detoxifier.
Development mechanism
Cough is a symptom of left ventricular failure. This is a condition in which the left ventricle cannot contract with enough force to push the entire volume of blood into the aorta. It remains in the cavity of the ventricle, which leads to its hypertrophy. It takes more force for the ventricle to push the blood out. Over time, a compensatory atrial dysfunction develops. Intra-atrial pressure rises because all blood cannot enter the ventricle during diastole. Due to the increased pressure, the muscular wall of the heart expands.
The pulmonary veins flow into the left atrium. Therefore, with an increase in intra-atrial pressure, pulmonary hypertension develops.
Pulmonary hypertension is a condition in which the pressure in the pulmonary vessels increases. There is a reflex irritation of the cough receptors, which provokes the development of cough.
In the acute form of the disease, there is a sharp decrease in the pumping function of the left ventricle, resulting in congestion in the pulmonary veins.
The occurrence of cough in pathology of the cardiac system is not associated with damage to the respiratory tract. The cardiac cough does not perform the protective function, that is, cleansing the airways.
Cough characteristic
Coughing is an unconditioned reflex characterized by increased exhalation through the mouth.
Symptoms of cough in heart failure have their own clinical features.
Cough in cardiac pathology is dry, that is, it is not accompanied by sputum production. It is characterized by paroxysmal, annoying, painful.
A cough attack is provoked by physical activity - exercise, walking, running. At rest, the intensity of the symptom decreases. It intensifies in a horizontal position, especially during sleep, so the symptom at night is characteristic. After getting up in the morning, coughing practically does not bother the patient. In the upright position, the symptom disappears or greatly diminishes.
Manifestations depend on the rate of development of the disease. In the acute form of the disease, a paroxysmal cough occurs sharply, regardless of the time of day, often against a background of relative well-being. In the chronic form, it is more permanent, arises from day to day, intensifies at night.
Associated symptoms
Cough in heart failure never occurs in isolation, while other clinical manifestations also occur. Some symptoms have a similar mechanism of development, they also arise from congestion in the lungs. The chronic form of the disease is characterized by:
- Dyspnea. It is characterized by a subjective feeling of difficulty in breathing. The patient has difficulty breathing, the respiratory rate increases. Dyspnea increases with exertion, decreases at rest.
- Hemoptysis. Sign of congestion in the lungs. It is characterized by the release of blood during coughing. The blood is released in small quantities, bleeding is not typical.
- Wheezing in the lungs. Signs are determined by auscultation of the lungs. The doctor uses a phonendoscope to listen to wheezing over the lung tissue.
In the acute form, there are other additional manifestations:
- Discharge of foam in copious amounts. Foamy discharge is pink in color, which is a sign of pulmonary edema.
- Dyspnea. Arises abruptly, in the form of an attack. It is characterized by a sharp difficulty in breathing.
- Orthopnea - the patient seeks to take a sitting position, as this facilitates his condition.
In case of insufficiency, the heart contracts with weakened strength, therefore it is not able to provide a normal blood supply to the organs, in this regard, there are signs of ischemia of internal organs and blood stagnation:
- pallor or blue skin;
- swelling of the lower extremities;
- an increase in the size of the liver;
- accumulation of fluid in the cavities - ascites, pleurisy;
- dizziness;
- decreased memory and other cognitive abilities.
Distinctive signs of cough in other diseases
Cough occurs in various diseases. It can be a sign of infection, diseases of the respiratory system, tumor formations. It is important to carry out differential diagnosis, since even with heart disease, coughing is not always a sign of heart failure, and the treatment tactics depend on the cause of the symptom.
A person with heart failure can get an acute respiratory viral infection (ARVI). Then the cough will be a manifestation of ARVI, and not heart disease. A cold cough is characterized by the following symptoms:
- mucous sputum is released;
- appears throughout the day, more in the morning;
- accompanied by an increase in temperature and signs of intoxication.
Diagnosis can be difficult when taking ACE inhibitors, a group of drugs that are often used to treat heart disease. They lower blood pressure, improve the state of the vascular endothelium. When they are taken, they often have a side effect in the form of a dry cough. This is due to the accumulation of bradykinin. You can determine the nature of the cough by the time the symptom occurs. As a side effect of ACE inhibitors, cough occurs in the first days of administration. To eliminate it, you must stop taking drugs.
A prolonged cough can be a symptom of pulmonary tuberculosis. Similar symptoms include hemoptysis and nighttime onset, characteristic of tuberculosis.
Distinctive symptoms characteristic of tuberculosis:
- temperature increase;
- sweating;
- signs of intoxication.
A cough can occur with any diseases of the respiratory system. With pleurisy, receptors located in the parietal pleura are irritated. The occurrence of cough with pleurisy is also not associated with damage to the upper respiratory tract. Pleurisy can also develop with heart disease. It is important to determine which disease led to the appearance of the symptom, since the tactics of treatment depend on this.
Research Supporting Cardiac Coughing
To determine that a cough is a sign of heart disease, not only clinical manifestations are taken into account, but also the test results.
The first method that is used for diagnosis is echocardiography (Echo-CG) of the heart. With the help of Echo-KG, several parameters can be estimated:
- the work of the left and right ventricles (for cardiac output);
- pressure in the chambers of the heart;
- pressure in large pulmonary vessels.
An additional diagnostic method is a plain chest x-ray. On the x-ray, you can see signs of pulmonary hypertension: expansion of the pulmonary artery, changes in the vascular pattern of the lungs. A sign of the underlying disease is also revealed - an increase in the size of the heart.
A cough suspected of heart failure requires careful diagnosis
Other instrumental studies can reveal changes in the heart, but will not confirm the nature of the symptom and the presence of pulmonary congestion.
Treatment tactics
The main thing in the choice of therapeutic tactics is to treat the underlying disease, not the symptom. Symptomatic treatment of cough in cardiac pathology is not carried out.
If the symptoms of heart failure are reduced, the heart cough will disappear. Treatment includes diet, medication, and surgery if necessary. Cough therapy is aimed at relieving pressure congestion.
The key to dieting in heart failure is limiting salt intake.
Drug treatment includes several groups of drugs:
- Beta blockers. Drugs in this group reduce the effect of the sympathetic nervous system on cardiac activity. Also, beta blockers have antiarrhythmic effects.
- Diuretics These are drugs that stimulate diuresis (excretion of urine). They reduce fluid accumulation and congestion. Against the background of their intake, the phenomena of stagnation in the lungs may decrease.
- ACE inhibitors. Prevents myocardial remodeling - the restructuring of the muscle wall of the heart, which leads to a decrease in contractile function.
- Cardiac glycosides. They are used to reduce the pumping ability of the heart. Cardiac glycosides increase the force of contractions, which leads to a decrease in congestion.
Treatment may include surgery. For example, valve replacement for mitral stenosis. Surgery can help reduce symptoms, including coughing and shortness of breath.
Video
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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