Can a Cough Be Related to Heart Issues?
Congestive Heart Failure And Heart Disease
Heart failure is when your heart can't pump enough blood to provide your body with the blood and oxygen it needs. If you have this condition, it doesn't mean your heart stops working. It means your heart doesn't work as efficiently as usual. Blood moves through your heart and body at a slower rate, and pressure in your heart raises.
The condition affects nearly 7 million Americans. About 1 in 4 people will get diagnosed with it in their lifetime. Heart failure is the main reason why people older than 65 go to the hospital.
An irregular heartbeat may be a symptom of heart failure. (Photo credit: E+/Getty Images)
Heart failure pathophysiology
Pathophysiology is the process that leads to heart failure. When your heart doesn't pump strongly enough, your body adapts so it can meet your body's need for blood.
The chambers of the heart may stretch so they can hold more blood to pump through your body. Or the heart muscle gets stiff and thicker to keep the blood moving. Over time, the extra work causes cells in the heart to die. The heart muscle walls get weaker and are less able to pump.
When your heart doesn't work well, your body releases hormones that narrow your blood vessels and make your kidneys hold onto more fluid (water) and salt. The extra fluid and salt raise your blood pressure and make your heart work even harder. Fluid builds up in your arms, legs, ankles, feet, lungs, or other organs. Doctors call this condition congestive heart failure.
In time, your heart gets so weak that it can't pump enough blood to meet your body's needs. That's heart failure.
Heart failure vs. Heart attack
Heart failure is different from a heart attack.
During a heart attack, a blood clot or the buildup of a sticky substance called plaque in your arteries blocks blood flow to your heart. Without oxygen, part of the heart muscle begins to die. You need quick treatment to open up the blocked blood vessel and restore blood flow to the heart.
Heart failure is a slower process. Your heart gradually becomes damaged from working too hard. Over time, it becomes less able to pump enough blood out to meet your body's needs.
Heart failure is caused by many conditions that damage the heart muscle, including:
You may not have any symptoms of heart failure. If you do have symptoms, they might be constant or come and go. They can be so mild you barely notice them or severe enough to affect your daily life.
Early signs of heart failure in adults
Look for these five early warning signs of heart failure:
Other heart failure symptoms include:
Heart failure can affect the left side of the heart, the right side of the heart, or both sides. Doctors also classify heart failure based on how well the heart can still pump.
Left-sided heart failure. This is the most common type. The left side of the heart, called the left ventricle, does most of the pumping. In left-sided heart failure, the left ventricle can't pump as much blood. The extra blood pools in the pulmonary veins—blood vessels that carry blood away from the lungs.
Doctors divide left-sided heart failure into two types based on the heart's pumping ability:
Systolic heart failure happens when the heart muscle doesn't contract with enough force to pump enough blood out to the body. Another name for this is heart failure with reduced ejection fraction (EF). EF measures how well your heart pumps with each beat.
Diastolic heart failure is when the heart contracts normally, but the ventricles don't relax properly or are too stiff. Less blood can fill the heart. Another name for this is heart failure with preserved EF.
Your doctor can tell you which of these conditions you have.
Your doctor will ask questions like these about your medical history:
Your doctor will also ask about your symptoms and do a physical exam. They will listen to your heart and look for signs of heart failure. And they will check for other illnesses that may have made your heart muscle weak or stiff.
Your doctor may also order tests like these to find the cause of your heart failure and to see how severe it is:
There are more treatment options available for heart failure than ever before. Lifestyle changes, medication, and careful monitoring are the first steps. If the condition gets worse, you may need to see a doctor who specializes in treating heart failure.
The goals of heart failure treatment are to prevent it from getting worse, relieve symptoms, and improve your quality of life.
Your doctor might first recommend lifestyle changes like these for early-stage heart failure:
Some common types of medicines used to treat heart failure are:
Your doctor may also recommend a program called cardiac rehabilitation to help you exercise safely and keep up a heart-healthy lifestyle. This program usually includes workouts that are designed just for you, along with advice to help you quit smoking and change your diet.
Cardiac rehab also offers emotional support. You'll meet other people with heart failure who can help you stay on track.
If those treatments don't work, you may need one of these procedures:
Coronary bypass surgery to route blood around a blocked artery.
Heart valve repair or replacement to fix or repair a damaged valve in your heart.
Implantable cardioverter defibrillator to put your heart back into a normal rhythm if it goes out of rhythm.
Cardiac resynchronization therapy, also called a biventricular pacemaker, to help your two lower heart chambers pump blood at the same time.
Ventricular assist device to pump in place of your heart until you can have surgery to fix the problem.
A heart transplant is an option for people with very severe heart failure who haven't improved with surgery or medicine. The surgeon replaces your damaged heart with a healthy heart from a donor.
Can heart failure be reversed?
That depends on the cause. Doctors consider heart failure reversed when the EF goes back to normal.
Some of the conditions that cause heart failure improve on their own, such as:
You may be able to bring the EF to normal if you:
The longer you've had heart failure and the more damage there is to your heart, the harder it is to reverse. A heart transplant may be the only way to reverse severe heart failure.
Heart failure often progresses or gets worse over time.
The American Heart Association and American College of Cardiology divide heart failure into four stages, based on how severe it is. Your doctor will recommend treatments for your stage of heart failure.
In the early stages, lifestyle changes like diet and exercise plus medication may be enough to treat heart failure. Later stages may need surgery or a heart transplant to correct.
Stage A. You're at a risk of heart failure because of a condition like high blood pressure, diabetes, or blood vessel disease. But you don't have any symptoms or problems with your heart.
Stage B. You don't have symptoms, but you do have raised pressure in your heart or problems with your heart's structure.
Stage C. You have or have had symptoms of heart failure.
Stage D. Your heart failure symptoms are severe enough to get in the way of your daily life or put you in the hospital.
The New York Heart Association divides heart failure into four categories based on how much it affects your activity level:
Class 1. Heart failure doesn't affect your activity.
Class 2. Heart failure slightly limits your activity. You have symptoms like tiredness, shortness of breath, heart palpitations, or chest pain when you do daily activities.
Class 3. Heart failure noticeably limits your activities. Even mild activity causes tiredness, shortness of breath, heart palpitations, or chest pain.
Class 4. You have heart failure symptoms even when you're at rest.
Follow these tips to protect your heart and slow heart failure:
Treat high blood pressure. In heart failure, blood vessels narrow. Your heart must work harder to pump blood through those narrowed vessels. It's important to keep your blood pressure controlled so that your heart can pump more effectively without extra stress.
Monitor your symptoms. Weigh yourself every day and check your body for swelling. These are signs that you're holding onto fluid. Call your doctor if you gain 3 pounds in 1 day or 5 pounds in 1 week or if you notice any swelling.
Keep a balance of fluids. Your doctor may ask you to write down how much fluid you drink and how often you go to the bathroom. The more fluid you carry in your blood vessels, the harder your heart must work to pump the extra fluid through your body. You may need to reduce the amount of fluid you drink to lower your heart's workload and prevent heart failure symptoms.
Limit salt (sodium). Sodium is naturally in some foods and added to others for flavor or to make food last longer. If you follow a low-sodium diet, you should retain less fluid, have less swelling, and breathe more easily.
Be aware of new or worsening symptoms. Call your doctor if you have new symptoms or if the symptoms you had get worse.
Take your medications as prescribed. Medicines improve your heart's ability to pump blood, lower stress on your heart, slow heart failure, and prevent your body from holding onto fluid. Heart failure drugs help your blood vessels widen and relax, which lowers blood pressure.
Schedule regular doctor appointments. During follow-up visits, your doctors will make sure that you stay healthy and your heart failure doesn't get worse. They will go over your weight and list of medications. If you have questions, write them down and bring them to your appointment. Call your doctor with any urgent questions between visits. Notify all your doctors about your heart failure, medications, and any restrictions. Also, check with your heart doctor about any new medications prescribed by another doctor. Keep good records and bring them with you to each doctor visit.
In an effort to prevent further heart damage:
How can I prevent further damage to my kidneys?
Heart failure raises your risk of chronic kidney disease. Your damaged heart sends less blood to your kidneys. Without oxygen-rich blood, your kidneys can't filter your blood as well. Heart failure and kidney disease also share risks like diabetes and high blood pressure.
These are some ways to protect your kidneys:
A few medications can cause problems for people with heart failure, including:
If you take any of these drugs, discuss them with your doctor.
It's important to know the names of your medications, what they're used for, and how often and at what times you take them. Keep a list of all your medications and bring them with you to each of your doctor visits.
Don't stop any heart failure medication without first talking to your doctor. Even if you have no symptoms, your medications lower your heart's workload so that it can pump better.
There are several things you can do to improve your quality of life if you have heart failure. Among them:
Heart failure diet
A few changes in your diet can reduce the workload on your heart and help improve your symptoms.
In heart failure, surgery may sometimes prevent further damage to the heart and improve the heart's function. Procedures used include:
Heart failure management is a team effort, and you are the key player on the team. Your heart doctor will prescribe your medications and manage other medical problems. Other team members—including nurses, dietitians, pharmacists, exercise specialists, and social workers—will help you achieve success.
If you notice anything unusual, don't wait until your next appointment to discuss it with your doctor. Call them right away if you have:
Go to the ER or call 911 if you have:
With the right care, heart failure may not stop you from doing the things you enjoy. Your prognosis or outlook for the future will depend on how well your heart muscle is functioning, your symptoms, and how well you respond to and follow your treatment plan.
Everyone with a long-term illness such as heart failure should discuss their desires for extended medical care with their doctor and family. An advance directive or living will is one way to let everyone know your wishes. A living will expresses your desires about the use of medical treatments to prolong your life. This document is prepared while you are fully competent in case you are unable to make these decisions at a later time.
About one-quarter of Americans will develop heart failure in their lifetime. Conditions like high blood pressure, diabetes, and CAD raise the risk. If your doctor has diagnosed you with heart failure, make sure you are on a treatment plan and that you follow your doctor's advice to protect your heart from further damage.
Around half of people with congestive heart failure live for at least 5 years. How long you live depends on how severe your heart failure is and how you treat it.
What To Know About Heart Failure When You Have Diabetes
In June of 2022, a report from the American Diabetes Association highlighted heart failure as "an underappreciated complication of diabetes." According to that report, up to 22% of people with diabetes will develop heart failure, and the incidence of heart failure within the diabetes community is increasing.
"Heart failure is the most prevalent cardiovascular complication in people with diabetes," says Dr. Rodica Pop-Busui, a professor of diabetes at the University of Michigan and president of medicine and science at the American Diabetes Association. "In the U.S. Alone there are 37 million people diagnosed with diabetes, and heart failure in this population is a very serious health care problem that needs to be addressed before it reaches more advanced and more costly stages."
For a time, it was thought that heart failure might mainly affect people with Type 2 diabetes. But the latest research suggests that people with Type 1 diabetes are also at risk. "When you look at all people with diabetes, either Type 1 or Type 2, the incidence of heart failure is four times higher than it is in the general population," says Dr. Amgad Makaryus, a professor of cardiology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New York.
The term "heart failure" refers to problems with the heart muscle's ability to pump blood. These problems can deprive other parts of the body of sufficient oxygen and blood. They can also cause fluid buildup in the lungs, abdomen, and limbs. Heart failure can produce a wide range of symptoms, and it can also lead to organ damage or sudden death. Heart failure is not only more common in people with diabetes than in the general population, but it may be more deadly. A study of more than 36,000 people in the European Journal of Heart Failure found that median survival was reduced by more than a year among those who had both heart failure and Type 2 diabetes compared to those with heart failure alone.
Here, experts explain the connection between the two medical conditions. They detail the heart failure signs and symptoms to watch out for if you have diabetes, and the best available courses of treatment. They also offer advice for people with diabetes who want to lower their risks for heart failure.
The connection between heart failure and diabetesAmong people with diabetes, glucose (also known as blood sugar) does not move out of the blood and into the cells the way it should. This leads to elevations of both blood glucose and insulin, which is a hormone that helps clear the blood of glucose. These elevations may contribute to the development of heart failure in some people with diabetes. "Elevations in glucose levels and elevations in insulin levels can cause damage at a molecular level to cells of the heart," Makaryus says.
But that's far from the only connection between the two conditions. "Mechanistically, there are several processes that affect people with diabetes that raise their risk for heart failure," says Dr. James Januzzi, a professor of medicine at Harvard Medical School and a clinical cardiologist at Massachusetts General Hospital. Januzzi says that, besides increasing risk for coronary artery disease, diabetes can cause direct injury to the heart muscle, resulting in stiffening and weakening that can culminate in heart failure. Research has linked diabetes to mitochondrial dysfunction, oxidative stress, inflammation, and an increase in the formation of harmful compounds called advanced glycation end products, or AGEs—all of which can contribute to the development of heart failure. "Diabetes is associated with a shift from glucose-related metabolism in the heart to the production of the sugar alcohol sorbitol, which may lead to cell death with scarring of the heart muscle," Januzzi explains. "We also know that individuals with diabetes are at higher risk for chronic kidney disease, which is an independent risk factor for heart failure." For all of these reasons, he says that the mere presence of diabetes is now considered a primary risk factor for heart failure.
Read More: How Stress Affects Your Heart Health
Signs and symptoms of heart failureThe symptoms of heart failure tend to be the same whether or not a person has diabetes. Fatigue lands at or near the top of the list, although at first this symptom may be subtle. "Someone may just feel like they don't have the same energy they used to," Januzzi says. Shortness of breath is another cardinal symptom of heart failure, but this may be difficult to spot if a person's fatigue has caused them to cut down on physical activity. "Frequently I'll ask a patient if they get shortness of breath and they'll say no, but it's because they've reduced their activity," he says. As heart failure progresses, these symptoms tend to become much more noticeable. For example, shortness of breath can show up even after very mild physical activity, such as walking up a few stairs.
"Another classic sign is not just shortness of breath when you exercise, but shortness of breath when you're lying down, or that wakes you from sleep," says Makaryus. "This has to do with fluid overload in the lungs as a result of the heart not pumping the way it should." Fluid overload can also lead to swelling (or edema) in the legs or abdomen of people with heart failure, he says.
While those are the most common symptoms, others include wheezing, weakness, a rapid or irregular heartbeat, nausea, weight gain, problems thinking or concentrating, and a persistent unexplained cough (that may or may not bring up white or pink mucous). As heart failure becomes more advanced, all these symptoms tend to be less subtle. "The fatigue may become so great that someone can't complete their daily activities," Makaryus says.
It's important to note that many cases of heart failure pass through an early stage when there are no noticeable symptoms. However, at this stage the condition may already be detectable using certain blood tests. "We now have sensitive and specific biomarkers that can identify the earliest molecular changes in the heart that precede more overt structural change," Pop-Busui says. There are drug therapies available that are proven to reduce the progression of heart failure, and catching the condition at this early, asymptomatic stage can help doctors improve outcomes for their patients. On the other hand, some diabetes medications can contribute to the development of heart failure. If the condition is caught early, someone with diabetes can get off these drugs before the condition progresses. "Early diagnosis can help make sure that people with diabetes have access to the best treatments at the right time," Pop-Busui says.
Treatment optionsThe standard, first-line treatments for heart failure are medications, and experts say the drugs they choose are based on the severity of the condition. "We look at something called the ejection fraction, or the squeezing strength of the heart, to determine the appropriate treatment plan," Januzzi says.
If a patient's ejection fraction is reduced—meaning their heart is not pumping as strongly as it should—treatment usually includes several classes of drug that are designed to widen blood vessels and improve blood flow. "There are four main classes of therapy we recommend," he says. These include beta blockers, aldosterone blockers, a medication called sacubitril/valsartan that widens blood vessels, and what's known as an SGLT-2 inhibitor, which not only lowers blood pressure but also helps reduce blood glucose levels. (SGLT-2 inhibitors are often used to treat diabetes even absent heart failure.)
"For people with preserved ejection fraction, meaning anormal squeezing strength, therapeutic options are more limited," Januzzi says. "However, recent clinical trials of SGLT-2 inhibitors showed benefit in these individuals, so these should be now considered in anyone with heart failure, but especially in people with diabetes."
"In my opinion, these are very important drugs," Makaryus says of SGLT-2 inhibitors. "Initially these were marketed as diabetes medications because they have blood sugar lowering effects, but clinical trials have found they improve outcomes and all-cause mortality from major cardiovascular events, including heart failure." He says that another newer class of drug called GLP-1 agonists has also demonstrated benefit in people with both diabetes and heart failure, and is likely to be used more frequently to treat these co-occurring conditions.
The drugs used to treat heart failure in people with diabetes are often the same drugs prescribed for those without diabetes, but there's evidence that they work even better in people with both conditions. "I tell my patients with diabetes they can expect even larger reductions in risk than someone without diabetes," Januzzi says.
Apart from drugs, lifestyle and behavioral changes can make a meaningful difference for people with heart failure. "This includes increasing exercise whenever possible," Januzzi says. "This also includes paying attention to one's mood." Depression and anxiety are both associated with poorer outcomes in people with heart failure, he says, so it's necessary to address these mental health challenges (with therapy, for example) if they appear.
"Diet and weight loss are also critically important," Januzzi says. "At our institution, we often recommend a Mediterranean-style diet that includes more complex carbohydrates and a judicious amount of protein." While there's a lot of strong research supporting the health benefits of Mediterranean-style diets, he notes that people with diabetes and heart failure should ideally work with a medical dietitian or nutritionist to create a custom eating plan. "Each individual patient has their own set of medical issues that might need to be considered," he says. There's no optimal, one-size-fits-all diet for people with diabetes and heart failure.
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Preventing heart failureWhile everyone should prioritize heart health, taking steps to lower your risks for heart failure is especially important if you've been diagnosed with diabetes. "Even for those individuals with relatively new-onset diabetes, the condition may have been present for a while, and so the clock has already been ticking," Januzzi says. "There's no better time than now to focus on wellness."
Controlling your risk factors for heart failure is step one, and that means not smoking, first and foremost, and also managing your cholesterol, blood pressure, and blood glucose through a combination of diet, exercise, weight loss, and medication therapy. "I also encourage my patients with diabetes to educate themselves so they understand their condition and the early warning signs of heart failure," Januzzi says. Keeping yourself informed on the latest regarding your disease, your risk factors, your medication options, and your screening options is still a good idea. "I always advise my patients to be their own advocates," he adds.
Heart failure is a common complication for people with diabetes. But with the right plan, you and your care team can take steps to effectively prevent or treat the condition.
Diastolic Heart Failure Vs. Congestive Heart Failure: What's The Difference?
Diastolic heart failure means there's a problem with your heart's ability to fill with blood. It's a type of congestive heart failure where your heart cannot work efficiently, leading to fluid overload in your body.
Congestive heart failure (CHF) is an umbrella term for heart failure that causes fluid buildup in the body.
Diastolic heart failure and systolic heart failure are two types of congestive heart failure. Both affect your heart's ability to pump blood to the rest of your body.
Heart failure is a serious, lifelong condition that requires medical attention. It's also relatively common, with an estimated 6.5 million adults in the United States living with this condition.
This article takes a closer look at diastolic and congestive heart failure.
While heart failure is a serious condition, this doesn't mean that your heart has suddenly stopped working, as is the case with cardiac arrest. Instead, this means that your heart is not pumping blood like it should. The extent of heart failure also depends on its type.
Diastolic heart failureDiastolic heart failure is a type of left-sided heart failure that occurs when the heart's left ventricle can't relax enough to fill with enough blood. This causes a smaller amount of blood to be pumped out to your body.
When you have diastolic heart failure, your heart is still trying to pump blood, but it has to work harder to fulfill its basic functions.
Diastolic heart failure may also be referred to as heart failure with preserved ejection fraction (HFpEF). Ejection fraction is a measure of how much blood is pumped out of the left ventricle every time your heart muscle contracts.
Congestive heart failureCongestive heart failure is a term for any type of heart failure with symptoms of congestion.
Congestive heart failure affects the pumping ability of your heart muscle and is chronic and progressive. When the ventricles of your heart can't pump enough blood to your body, blood and other fluids can eventually back up inside your:
The symptoms of diastolic heart failure are the same as congestive heart failure.
Some types of diastolic heart failure will have additional symptoms based on the underlying cause. For example, cardiac amyloidosis can have other symptoms, such as:
In their early stages, neither diastolic nor congestive heart failure may cause any noticeable symptoms. However, as the heart pumps less blood to cells and tissues over time, you may experience:
Heart failure — whether diastolic or congestive — is treated with diuretics and management of the underlying conditions.
Doctors may also use medications to treat the underlying condition (such as high blood pressure) or to help relax blood vessels and improve overall heart function.
These medications may include:
Additionally, a doctor may suggest lifestyle modifications to help complement treatment for heart failure. These include:
A heart transplant may be necessary for refractory heart failure when other treatments don't work. Refractory heart failure is the term doctors use when symptoms are persistent and severe enough to affect daily life, despite having medical therapy.
Overall, about 50% of people with heart failure live 5 years or longer. A 2019 study found that the average survival rate dropped to 35% after 10 years.
The exact outlook depends on the type and severity of heart failure you have, as well as your age and any underlying conditions and complications.
Also, experts consider diastolic heart failure difficult to treat compared with other types of heart failure. This is because many of the medications that are effective in systolic heart failure often don't show the same results in diastolic heart failure.
There's no cure for heart failure, but treatments can help reduce symptoms and help protect your heart from further strain. This includes diastolic heart failure, which is a type of congestive heart failure.
While diastolic heart failure affects the left side of your heart, and congestive heart failure is known for causing fluid buildup, both affect your heart's ability to pump blood normally. This can lead to serious complications if left untreated.
Since heart failure doesn't usually cause any obvious symptoms in its early stages, regular checkups with a doctor are key to detecting related conditions in a timely manner. However, if you're experiencing possible heart-related symptoms, don't wait till your next scheduled appointment, see a doctor right away.
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