Spotting the early symptoms of heart failure can mean the difference between life and death, but the signs are often so varied and subtle that people can miss the warning signs.
Some of the most well-known symptoms of heart failure include shortness of breath, difficulty breathing when lying down and coughing, according to Eva Shelton, MD, physician of internal medicine at Brigham and Women’s Hospital. “There are two main types of heart failure physiology, left-sided and right-sided heart failure,” explains Shelton. “When left-sided heart failure occurs, blood and the fluid it contains backs up into the lungs, resulting in shortness of breath and coughing.”
But since a cough can indicate the onset of many conditions, from the common cold to thyroid problems, how can you tell when it’s actually a sign of heart disease? Read on to find out.
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When blood pools in the lungs due to heart failure, the leaked fluid “essentially makes the lungs feel like they’re drowning,” explains Shelton. “The lungs get irritated and try to expel this water, so the natural response is to cough. Since this cough is a result of fluid accumulating in the lungs, it often sounds like ‘wet’. Looks like there’s some water [and/or] coughing sputum.”
While a wet cough can indicate heart disease, a dry, wheezing cough can also be a symptom. “There are also situations where the lungs can’t release as much fluid, so the cough sounds drier,” warns Shelton. This is known as cardiac asthma.
“Heart failure can cause fluid to build up in the lungs (pulmonary edema) and in and around the airways,” according to the Mayo Clinic. “This can cause shortness of breath, coughing and wheezing similar to the signs and symptoms of asthma.”
If your cough produces bloody or pink mucus, that could be a symptom of heart failure, reports the American Heart Association. This happens when your heart can’t keep up with the blood supply, which then “backs up” in the vessels (pulmonary veins) that transfer blood from your lungs to your heart. The mucus may also appear foamy or white.
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When the lungs are affected by fluid buildup and the resulting coughing wakes you up during the night, this could be paroxysmal nocturnal dyspnea (PND) according to Verywell Health:”[PND] is characterized by being awakened during sleep with severe shortness of breath, shortness of breath, coughing, and feeling the need to sit up, stand up, and/or open a window for air – all of which can help breathing improve after a few minutes .”
“I’ve met patients who were first diagnosed as having a breathing problem,” heart failure specialist Miriam Jacob, MD, told the Cleveland Clinic. “Over time, when symptoms did not improve with proper treatment, heart failure was considered a diagnosis.”
The most common reasons for a prolonged cough are asthma or chronic obstructive pulmonary disease — two conditions that cause inflammation in the lungs that can be treated, reports the Cleveland Clinic. If a persistent cough persists even after treatment for these conditions, heart disease may be the cause.
The same buildup of fluid that makes you cough can also result in a sensation that Medical News Today describes as similar to “popping, gurgling, or like a blister is about to burst.”
Shelton recommends that if you experience this or any other symptoms of heart disease, speak with your doctor to evaluate and possibly treat the condition. “In the meantime for symptom control, it can help to sleep reclined so you’re not so breathless lying down, elevating your legs to help with edema, oxygen therapy to help your lungs oxygenate, not pushing yourself too hard, etc…,” she advises .