Coughing and heart failure: what should you know?

Heart failure means the heart is not moving blood around the body as effectively as it should. Pressure can then rise in the blood vessels of the lungs, allowing fluid to collect and irritate the airways. The cough may be dry or produce frothy mucus, and it can be worse when lying flat or at night. Breathlessness, tiredness, swollen ankles, rapid weight change, or reduced exercise tolerance may appear with it. A cough can also come from a cold, asthma, reflux, smoking, or a medicine, so it should not be used alone to identify heart failure.

A new cough in someone with known heart failure may signal a change in fluid balance or another illness. The timing, triggers, mucus, and accompanying symptoms are useful details for assessment.

If you have heart failure, take prescribed medicines as directed and do not stop them because of a cough without speaking with your care team. Record when the cough occurs, whether it is worse when lying down, and any change in ankle swelling or breathlessness. Sit upright to rest if lying flat aggravates symptoms. Contact your clinician promptly about a new or worsening cough so they can review your medicines, lungs, heart symptoms, and fluid plan. A [Chronic Disease Review](/treatments/consultations-and-assessment/chronic-disease-review/) can help organise this review.

Call emergency services for severe breathlessness at rest, chest pressure, fainting, blue or grey lips, confusion, or coughing up pink or bloody froth. Seek same-day advice if breathlessness is increasing, you cannot lie flat, swelling is rapidly worsening, or you feel markedly weaker. These changes need clinical assessment rather than home monitoring.

Ask whether your symptoms fit [Heart Failure](/conditions/heart-failure/), whether a medicine could be contributing, and what change in swelling or breathlessness should trigger a call. Mention any [Fatigue](/symptoms/fatigue/), [Palpitations](/symptoms/palpitations/), or [Swollen Ankles](/symptoms/swollen-ankles/).