Congestion and Heart Failure: Causes, Signs & Symptoms | Max Hospital

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Chronic Cough: Could be a Sign of Heart Failure!

By Dr. Amit Malik in Cardiac Sciences

Jul 03 , 2024 | 10 min read

Chest congestion and heart failure are seldom considered to be related. In fact, most people regard coughing as an issue related to the lungs. However, not many people know that a chronic cough or congestion is also an indication of heart failure, a condition clinically referred to as congestive heart failure (CHF). At times, people who suffer from heart failure experience a persistent cough that can also contain some blood. This mostly occurs when heart failure progresses to an advanced stage. To ensure a healthy and safe life, people must know whether their chronic cough is an indication of heart failure and if yes then what are the steps they need to take. Here is all one needs to know about the connection between cough and heart failure.

What is Congestive Heart Failure?

Congestive heart failure is a medical condition that occurs when heart muscles are unable to pump blood properly. This is a chronic and progressive heart complication which is usually caused by conditions such as coronary artery disease, hypertension, and heart valve disease among others.

Connection Between Cough and Heart Failure

Lung congestion is one of the possible issues that could come up with weak functioning of the heart muscle. This happens when the blood returning to the heart from the lungs tends to back up, which can lead to a situation where the fluid can leak into the airspace (alveoli) of the lungs. This congestion then results in a cough.

Causes of Congestive Heart Failure

Congestive heart failure ( can result from various conditions that affect the heart's ability to pump blood effectively. The causes of congestive heart failure can be broadly categorized into two types: conditions that directly damage the heart muscle, and conditions that strain the heart by increasing its workload. Here are some common causes:

  • Coronary artery disease (CAD): CAD, characterized by the buildup of plaque in the coronary arteries, can lead to reduced blood flow to the heart muscle, causing heart muscle damage over time.
  • Myocardial infarction (Heart attack): A heart attack occurs when blood flow to a part of the heart muscle is blocked. The resulting damage can weaken the heart's pumping ability, contributing to heart failure.
  • Hypertension: Persistent high blood pressure forces the heart to work harder to pump blood, leading to hypertrophy (enlargement) of the heart muscle. Over time, this can result in heart failure.
  • Cardiomyopathy: Conditions that directly affect the heart muscle, such as dilated cardiomyopathy or hypertrophic cardiomyopathy, can weaken the heart and contribute to heart failure.
  • Heart valve problems: Malfunctioning heart valves, such as aortic stenosis or mitral regurgitation, can lead to an increased workload on the heart and result in heart failure.
  • Infections: Viral infections, myocarditis, or endocarditis can cause inflammation and damage to the heart muscle, impacting its pumping function.
  • Congenital heart defects: Structural abnormalities present from birth can affect the heart's normal function and lead to heart failure over time.
  • Diabetes: Uncontrolled diabetes can contribute to atherosclerosis (narrowing of arteries) and hypertension, both of which are risk factors for heart failure.
  • Obesity: Excess body weight can lead to conditions such as hypertension and diabetes, increasing the risk of heart failure.
  • Chronic lung diseases: Conditions such as chronic obstructive pulmonary disease (COPD) can strain the heart by affecting lung function, leading to heart failure.
  • Thyroid imbalance: Both hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) can contribute to heart failure if not properly managed.
  • Alcohol and substance abuse: Excessive alcohol consumption or the use of certain drugs can directly damage the heart muscle, leading to heart failure.

It's important to note that often multiple factors may contribute to the development of congestive heart failure, and addressing underlying causes is crucial for effective management. Individuals with risk factors or symptoms should seek medical attention for early diagnosis and intervention.

Signs and Symptoms of Congestive Heart Failure

A cough that is associated with heart failure can be accompanied by heavy wheezing and labored breathing. In advanced stages, patients cough with frothy sputum and some blood.

According to Dr. Amit Malik, Principal Consultant, Interventional Cardiology - Electrophysiology, Max Super Speciality Hospital, Vaishali, patients dealing with congestive heart failure may experience the following symptoms:

  • Shortness of breath (Dyspnea): Difficulty in breathing, especially during physical activity or when lying down.
  • Persistent coughing or wheezing: Coughing that may produce white or pink blood-tinged phlegm.
  • Fluid retention and swelling (Edema): Swelling in the legs, ankle, abdomen, or other dependent areas due to fluid retention, typically accompanied by weight gain.
  • Fatigue and weakness: Feeling tired and weak, often as a result of the heart's reduced ability to pump blood.
  • Rapid or irregular heartbeat (Arrhythmias): Palpitations or a feeling of fluttering in the chest, which may be due to irregular heart rhythms.
  • Reduced exercise tolerance: Inability to tolerate physical exertion or exercise as well as before.
  • Increased heart rate: A heart rate that is higher than normal, especially at rest.
  • Difficulty concentrating or mental confusion: Impaired cognitive function or confusion, which may be linked to inadequate blood flow to the brain.
  • Loss of appetite or nausea: Reduced interest in food or a feeling of queasiness.
  • Sudden weight gain: A rapid increase in body weight due to fluid retention.
  • Elevated blood pressure: Hypertension may be present, contributing to the workload on the heart.
  • Increased urination at night: Frequent nighttime urination, which could be a sign of fluid redistribution and increased stress on the heart.

In case a person experiences the symptoms mentioned above along with a persistent cough, they should consult a doctor instead of self-speculating about the possible health complications. A cardiac cough is usually a sign that the heart failure is worsening and the best thing a patient can do to avoid a fatal situation is to get the appropriate treatment without any delay, and start focusing on a healthy lifestyle.

Note: Chronic cough could also be a side effect of the medications that are usually prescribed for heart failure. However, the cough that occurs as a side-effect is annoyingly dry, with throat irritation.

Diagnosis of Congestive Heart Failure

The diagnosis of congestive heart failure) involves a comprehensive assessment that combines medical history, physical examination, and various diagnostic tests. Here is an overview of the diagnostic process:

  • Medical history and physical examination: The doctor will review the patient's medical history, including any existing health conditions, family history, and lifestyle factors, and a thorough physical examination will be conducted to assess signs of heart failure.
  • Blood tests: Blood tests are conducted to evaluate various parameters, including kidney function, liver function, electrolyte levels, and blood counts. Elevated levels of certain substances may indicate heart failure.
  • Natriuretic peptides: Blood tests measuring natriuretic peptides, such as B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP), can help assess the severity of heart failure. Elevated levels are indicative of heart stress.
  • Chest X-ray: A chest X-ray provides images of the heart and lungs, helping to identify signs of heart failure such as an enlarged heart or fluid accumulation in the lungs.
  • Electrocardiogram (ECG or EKG): An ECG records the electrical activity of the heart, helping identify irregular heart rhythms and patterns indicative of heart failure.
  • Echocardiogram: An echocardiogram uses ultrasound waves to create images of the heart's structure and function. It helps assess the heart's pumping ability, valve function, and the presence of any structural abnormalities.
  • Stress test: Stress tests, including exercise stress tests or pharmacological stress tests, evaluate the heart's response to increased workload. They help identify abnormalities in blood flow and assess overall cardiovascular function.
  • Cardiac MRI or CT: These imaging techniques provide detailed images of the heart's structure and function, helping to identify abnormalities and assess overall cardiac health.
  • Coronary angiography: In some cases, a coronary angiogram may be performed to visualize the coronary arteries and identify blockages or narrowing that may contribute to heart failure.
  • Radionuclide ventriculography (MUGA scan): This nuclear medicine test assesses the heart's pumping function and helps evaluate the severity of heart failure.
  • Holter monitor or event monitor: Continuous monitoring devices can record the heart's electrical activity over an extended period, helping to identify irregular rhythms or episodes of heart failure symptoms.

The combination of these diagnostic tools allows healthcare professionals to accurately diagnose congestive heart failure, determine its underlying causes, and tailor a treatment plan to address the specific needs of the patient.

Treatment for Congestive Heart Failure

The treatment for congestive heart failure (CHF) aims to manage symptoms, improve the heart's function, and enhance the patient's quality of life. Though treatment plans are individualized based on the underlying cause, the severity of the condition, and the patient's overall health, here are some common components of CHF treatment:

Lifestyle modifications

  • Dietary changes: A heart-healthy diet low in sodium is often recommended to reduce fluid retention. This may include limiting salt intake and managing fluid consumption.
  • Regular exercise: A supervised exercise program can help improve cardiovascular health and overall well-being. The type and intensity of exercise depend on the individual's health status.


  • Diuretics (Water pills): Diuretics help the body eliminate excess fluid, reducing swelling and congestion in the lungs.
  • Angiotensin-converting enzyme (ACE) inhibitors: These medications help relax blood vessels and reduce the heart's workload, improving its pumping efficiency.
  • Beta-blockers: These drugs can slow the heart rate and decrease blood pressure, reducing strain on the heart.
  • Angiotensin II receptor blockers (ARBs): Similar to ACE inhibitors, ARBs help relax blood vessels and reduce strain on the heart.
  • Aldosterone antagonists: These medications help regulate sodium and fluid balance, supporting heart function.
  • Digoxin: In some cases, digoxin may be prescribed to strengthen the heart's contractions.


  • Implantable cardioverter-defibrillator (ICD): For those at risk of life-threatening arrhythmias, an ICD can monitor and correct abnormal heart rhythms.
  • Cardiac resynchronization therapy (CRT): This involves the use of a special pacemaker to improve coordination between the heart's chambers.

Surgical Interventions

  • Coronary artery bypass grafting (CABG): In cases of coronary artery disease, CABG may be recommended to improve blood flow to the heart.
  • Heart valve repair or replacement: Repairing or replacing damaged heart valves can improve overall heart function.
  • LVAD: LVADs are mechanical pumps that are attached directly to the heart. One end of the pump is attached to the left chamber (left ventricle) which helps pump blood out of the ventricle to the aorta and then to the rest of the body. They take over most of the work of the heart and help people with advanced heart failure return to a more normal life.
  • Heart transplant: In severe cases of heart failure, when other treatments are insufficient, a heart transplant may be considered.

Individuals with congestive heart failure must work closely with their doctors to develop and adjust a comprehensive treatment plan tailored to their specific needs. Early diagnosis and consistent management can significantly improve outcomes and quality of life for those living with heart failure.

Wrap Up

To understand this distinction in a cough, one can consult a cardiologist and clear their doubts. We, at Max Healthcare, the best heart hospital in Delhi, offer world-class cardiac treatment to our patients. Our team, comprising some of the best cardiologists in Delhi, not only focuses on the treatment but also guides the patients about the treatment and the side-effects of the medications if there are any. At times, some people are not even sure if they are experiencing heart attack symptoms or heart failure symptoms. Our trusted professionals also clear these doubts and spread awareness among the patients.

Frequently Asked Questions about Congestive Heart Failure

Q: Can Congestive Heart Failure be Cured?

While congestive heart failure may not always be cured, effective management strategies, lifestyle changes, and medical treatments can significantly improve symptoms and quality of life.

Q: Is Heart Failure the Same as a Heart Attack?

No, heart failure and heart attacks are different. A heart attack is a sudden blockage of blood flow to the heart, while heart failure is a chronic condition where the heart can't pump blood effectively.

Q: Can Congestive Heart Failure be Prevented?

Adopting a heart-healthy lifestyle, managing risk factors (e.g., hypertension, diabetes), dyslipidemia and seeking prompt medical attention for cardiovascular issues can reduce the risk of developing heart failure.

Q: Can Heart Failure Affect Younger Individuals?

Yes, while heart failure is more common in older adults, it can affect individuals of any age, including younger people with underlying heart conditions or congenital heart defects.

Q: Are There Specific Dietary Restrictions for Heart Failure Patients?

A heart-healthy diet low in sodium is often recommended for heart failure patients. This may include limiting salt intake, managing fluid consumption, and adopting a balanced diet rich in fruits, vegetables, and lean proteins.

Q: Can Stress Worsen Heart Failure Symptoms?

Yes, stress can contribute to the worsening of heart failure symptoms. Managing stress through relaxation techniques, support networks, and, if needed, counseling can be beneficial.

Q: Can Heart Failure be Managed Without Medications?

Medications are often a key component of heart failure management. However, lifestyle changes, including a heart-healthy diet, regular exercise, and stress management, are also essential for overall well-being.