Heart failure cough

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Heart Failure and Chronic Cough: Understanding the Connection

Introduction to Heart Failure and Cough

Heart failure (HF) is a condition where the heart is unable to pump blood effectively, leading to symptoms such as breathlessness, fatigue, and fluid retention. Interestingly, chronic cough is also a symptom that can be associated with heart failure, although it is often overlooked in clinical practice. This article explores the relationship between heart failure and chronic cough, highlighting key findings from recent research.

Chronic Cough as a Symptom of Heart Failure

Tachycardia-Induced Cardiomyopathy (TIC) and Cough

Tachycardia-induced cardiomyopathy (TIC) is a condition where persistent high heart rates lead to heart muscle dysfunction. A case study of a young woman with TIC revealed that heart failure can present with chronic cough, even in the absence of other typical symptoms like exertional dyspnea or limb edema. The patient's left ventricular dysfunction improved with heart rate control, underscoring the importance of considering TIC in the differential diagnosis of chronic cough.

Cough in Chronic Heart Failure (CHF)

Chronic heart failure can lead to fluid accumulation in the lungs, known as acute pulmonary edema, which manifests as severe breathlessness and coughing. This condition requires urgent medical attention. Fluid buildup in other areas can also cause peripheral edema and venous congestion, contributing to cough.

Airway Hyperresponsiveness in Heart Failure

Research indicates that airway hyperresponsiveness is not a predominant feature in non-smoking patients with stable chronic heart failure who are treated with angiotensin-converting enzyme inhibitors (ACE-I). This suggests that airway inflammation is not a significant contributor to cough in these patients.

Diagnostic Tools and Technological Advances

TussisWatch: Smart-Phone System for Early Detection

TussisWatch is a smart-phone-based system designed to record and analyze cough episodes for early identification of chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF). The system uses a two-level classification scheme to differentiate between coughs indicative of disease and those that are not, achieving high sensitivity and specificity. This technology has the potential to facilitate early diagnosis and improve patient outcomes.

Automated Detection Using Cough Sounds

A novel diagnostic system has been developed to differentiate between COVID-19, heart failure, and healthy individuals using cough sounds. This system employs a graph-based local feature generator and a k-nearest neighbor classifier, achieving high accuracy in distinguishing between these conditions. Such automated systems can be valuable in clinical settings for rapid and accurate diagnosis.

Medication-Induced Cough

ACE Inhibitors and Cough

ACE inhibitors, commonly used in the treatment of hypertension and heart failure, are known to cause a dry cough in some patients. Studies have shown that the incidence of ACE-I-induced cough is higher in patients with heart failure compared to those with hypertension. This side effect often necessitates discontinuation of the medication, particularly in heart failure patients. A meta-analysis revealed that a significant portion of cough cases in patients on ACE-I could be attributed to other factors, emphasizing the need to rule out other causes before discontinuing the medication.

Enalapril-Induced Cough

Enalapril, an ACE inhibitor, has been associated with a higher incidence of cough in patients with less severe heart failure. This suggests that the presence of a cough could potentially serve as a marker for non-severe heart failure.

Conclusion

Chronic cough can be both a symptom and a consequence of heart failure. It is crucial for healthcare providers to consider heart failure in the differential diagnosis of chronic cough, especially in patients with other risk factors or symptoms of heart disease. Advances in technology, such as smart-phone-based diagnostic tools and automated cough sound analysis, offer promising avenues for early detection and management of heart failure. Additionally, understanding the side effects of medications like ACE inhibitors can help in better managing patients with heart failure who present with chronic cough.