Cardiac cough is a conditional medical term that reflects the development of various degrees of respiratory disorders in cardiac patients. In a separate clinical symptom, a cough of cardiac origin is allocated to this day because its occurrence in a patient suffering from heart disease, is an extremely unfavorable diagnostic feature.
It should be borne in mind that not all cardiac pathologies should be accompanied by the appearance of a cough, in the majority of cardiac patients the equivalent of a cardiac cough is observed - increasing dyspnea. The most severely affected patients suffer from cough with cardiac asthma, since this condition is characterized by severe cardiohemodynamic and respiratory disorders.
Causes of a heart cough
In some situations, the development of the patient's cardiac pathology for a long time is not accompanied by the formation of a clinical picture depicting the defeat of the structures of the cardiovascular system. This category of patients can be examined for a long time at a pulmonologist about the existing painful cough that occurs with increased physical activity. The duty of the attending physician in this situation is an additional detailed examination of this category of patients for the presence of asymptomatic cardiac pathology, since cough is a pathognomonic sign for the development of heart failure.
A separate group of cardiac pathologies that decompensate the activity of the heart is distinguished, including heart valve valvular defects, myocardial inflammatory diseases, ischemic heart damage and cardiomyopathies . Any organic damage to the heart structures sooner or later contributes to the development of heart failure, the consequence of which is stagnation in the venous collectors of both small and large blood circulation.
Thus, almost any cardiac pathology can provoke the development of a cardiac cough. The most common background diseases for the development of congestive heart failure is atherosclerotic disease with concomitant ischemic myocardial damage. With prolonged course, the ischemic foci in the myocardium undergo sclerotic changes, as a result of which the basic function of the heart worsens significantly. In addition, the progression of cardiac cough is promoted by the development of hypertension in the patient.
Insufficient blood filling of the lung tissue is inevitably accompanied by compensatory bronchospasm, which manifests itself in the appearance of a dry cough in the patient. Dry cardiac cough is one of the specific pathognomonic criteria of mediastinal diseases and aortic aneurysm. Uncomplicated pulmonary congestion is accompanied by the emergence of a cough pulse in the pulmonary parenchyma with its subsequent spread along the nerve pathways simultaneously with impulses of dyspnea, and therefore these symptoms are often combined with heart failure.
Cardiac cough in a child can develop against a background of congenital heart disease , accompanied by a hemodynamic discharge from left to right, which results in enrichment of the small circle of blood circulation and increased pressure in the lumen of the pulmonary artery.
Cardiac night cough is an important diagnostic criterion for the development of infective endocarditis , the occurrence of seizures of which has a clear dependence on the increase in the patient's temperature response in response to septic damage.
Thus, cardiac cough is either a manifestation of heart failure and venous stasis in the lungs, or a sign of damage to the human respiratory apparatus as a complication of cardiac pathology.
Symptoms and signs of a heart cough
The mechanism of development of cough as a complex reflex act is a sharp expiration on the background of the closure of the vocal cords, the development of which is aimed at removing the secret from the lumen of the bronchi. Since cough, like other respiratory disorders, is more a reflection of inflammatory, allergic respiratory tract infection, it is difficult to differentiate even cardiac cough in the initial stage of the disease.
There are absolute clinical characteristics that distinguish cough from heart diseases from similar respiratory disorders observed with organic respiratory tract infection. Thus, with mitral stenosis , the patient has episodes of dry paroxysmal cough with hemoptysis, accompanied by severe sweating and severe muscle weakness.
Patients suffering from cardiac pathology complicated by left ventricular failure describe a heart cough as a debilitating choking, which occurs mainly in the evening, to eliminate which the patient begins to cough. Relief of the condition comes only after the patient manages to recoup at least a minimum amount of sputum.
In a situation where the episode of a cardiac cough ends with the release of a large amount of sputum smut-brown color, it is necessary to assume the development of right ventricular failure, aggravating the patient's condition. Severe congestion in a small circulatory system combined with atrial fibrillation may be a favorable background for the development of thromboembolic syndrome, the main symptom of which is hemoptysis. In addition, this version of heart cough in almost 100% of cases is accompanied by a violation of the rhythm of cardiac activity and nonspecific cardial pain syndrome. Severe cardiac cough can provoke syncopal conditions, the occurrence of which is due to increased intrathoracic pressure, against which blood flow to the heart is significantly reduced.
The principal difference between cardiac cough and cough in the symptomatic complex of acute respiratory disease is the complete absence of signs of an infectious organism damage (temperature reaction, catarrhal phenomena in the nasopharynx, inflammatory changes in the laboratory blood test). In addition, cough with a heart attack is rarely accompanied by the secretion of bronchial secretions, while inflammatory diseases of the respiratory system are characterized by a productive cough with sputum purulent, less often mucous.
When examining a patient with a cough, it should be borne in mind that people suffering from cardiac pathology are more prone to inflammatory lesions of the tracheobronchial apparatus than others, so the occurrence of cough in this category of persons can be triggered not only by stagnation in a small circle of blood circulation. In this situation, it is expedient to comprehensively examine a patient with a mandatory determination of the presence of inflammatory elements in a bronchial secret.
In an objective examination of a patient suffering from a cardiac cough caused exclusively by venous stasis, single small bubble moist wheezing is auscultated, which do not have a clear localization. The presence of widespread dry whistling wheezing throughout the pulmonary fields on both sides is evidence in favor of the development of bronchitis . In a situation where a cardiac cough is complicated by the development of congestive pneumonia, a foci of wet wheezing with concomitant crepitus is auscultated.
Cough with heart failure
In the pathogenetic mechanism of cardiac cough development in heart failure, several stages are divided, with a long course of which the patient develops serious complications in the form of pulmonary edema and cardiac asthma . Most respiratory disorders develop with a pathological change in the left ventricle, which is manifested in a decrease in the intensity and regularity of its contraction. The result of such a prolonged decrease in the inotropic function of the left ventricle is a progressive increase in pressure in the vessels of the small circle of the circulation, which include pulmonary vessels. Slowed blood flow in the pulmonary capillaries provokes an increase in the venous type of pressure, as a result of which diffuse tissue hypoxia develops.
Prolonged hypoxic lesion is accompanied by increased production of collagen connective tissue fibers by fibroblasts, their accumulation in the projection of interalveolar septa and the development of widespread pneumofibrosis . Due to the fact that the blood vessels of the microcirculatory bed for a long time do not receive blood, most of them are obliterated, which further exacerbates the blood filling of the lungs.
As a result of the "shutdown" of a large number of small caliber vessels from the total pulmonary blood flow, conditions are created for increasing the pressure in the pulmonary artery system. The consequence of this increased intravascular pressure is a compensatory increase in myocardial contractility of the right ventricle, which provokes an increase in the thickness of the myocardium in this zone. With exhaustion of compensatory possibilities of the right heart, a progressive expansion of the right ventricular cavity develops. This situation is irreversible, as the patient develops a total venous congestion in both circulation circles. At this stage of the disease, patients make typical complaints about the onset of a heart cough, the intensity of which progressively increases at night, in connection with which, patients take a forced position with the head of the bed raised. These clinical manifestations are chronic, but when acute left ventricular failure occurs, respiratory disorders increase dramatically, and the typical symptomatology of pulmonary edema develops.
The time of appearance, frequency and duration of heart cough attacks in a patient is a diagnostic sign that characterizes the process of progression of congestive heart failure. So, in the initial stage, the cardiac cough worries only in the situation of the available fact of intense physical activity, which is unusual for a person. With persistent heart failure, attacks of a heart cough worried the patient with moderate physical or psycho-emotional activity, and the episode of this attack can last a fairly long time. The extreme degree of heart failure is manifested by severe respiratory disorders in the patient, in which cough and shortness of breath is observed in a person constantly, even during sleep.
Long-term course of heart cough with chronic heart failure is accompanied by the development of changes on the part of the patient's breathing apparatus, which consist of a decrease in the maximum ventilation capacity of the lungs, a decreased value of the vital capacity of lung tissue, and uneven ventilation of the pulmonary parenchyma. Such changes inevitably lead to the development of respiratory failure of a restrictive type, caused by a decrease in the mobility of the pulmonary parenchyma and an increase in bronchial resistance.
Provided conditions for impaired ventilation of the pulmonary parenchyma, hemodynamic disorders in the small circulation system, post-capillary pulmonary hypertension, stagnation and "sweating" of the liquid component of blood plasma into the alveoli, favorable conditions for the spread of infection and concomitant formation of pneumonic infiltration of the stagnant type are created.
The hemoptysis that occurs in cardiac patients, which is observed during a severe attack of cardiac cough, develops as a result of diapedesis and rupture of dilated bronchial and pulmonary capillaries. In some situations, rupture of the veins of the bronchial order may be accompanied by pulmonary hemorrhage, which is a fairly frequent complication of left ventricular heart failure .
Treatment of cardiac cough
Despite the fact that the main component of the treatment of cardiac cough is the use of medicamentous correction of hemodynamic disorders, as a result of heart failure, non-drug measures are of great importance, whose action is aimed at alleviating the patient's condition during an attack of cardiac cough.
The primary condition for the successful treatment of cardiac cough is the normalization of rest and physical activity. A patient suffering from cardiac pathology should spend enough time resting in a quiet environment, as well as a night's sleep.
In addition, a preventive measure aimed at preventing the progression of organic damage to the heart muscle, and as a consequence of a cardiac cough, is the correction of the patient's eating behavior. Patients suffering from heart failure, cardiologists recommend to sharply limit the use of table salt, as well as foods with high cholesterol. Of course, there is no question of alcohol consumption and smoking by the patient, as the correlation between the intensification of heart failure and bad habits has been scientifically proven.
Since heart cough is a reflection of the development of severe heart failure that occurs with various organic heart damage, drug treatment of this condition should be primarily etiologically directed. In most situations, the elimination or compensation of hemodynamic disorders by the use of drugs of various pharmacological groups, can neutralize manifestations of cardiac cough without the use of specific treatment. Unfortunately, patients with long-term heart cough do not realize the seriousness of the situation and seek medical help at the stage of decompensated heart failure, in which complete recovery of the patient is impossible. In this regard, the Cardiology Association offers an algorithm for screening patients with respiratory disorders, including an examination for the presence of organic cardiac pathology.
All medicinal groups of drugs used as a therapeutic means to combat heart cough should be pathogenetically justified, since the elimination of signs of heart failure in itself contributes to independent leveling of cough. Symptomatic drugs in the form of funds that depress the cough reflex or mucolytics are used only in the case of existing signs of infection of the bronchial infection.
The manifestation of signs of pneumonic infiltration in the lungs in the patient is the justification for the appointment of an adequate scheme of antibacterial therapy (Ceftriaxone 1 million units 2 times a day intramuscularly or intravenously). The duration of antibiotic therapy is controlled by indicators of blood analysis and X-ray dynamics.
Pathogenetically justified is the appointment of a patient with a cardiac cough of a group of diuretics, especially with the presence of concomitant signs of peripheral edematous syndrome, dyspnea with the presence of congestive wheezing in the lungs. This category of drugs contribute to the reduction of cardiac cough and even its complete disappearance, but it should be borne in mind that diuretic drugs have the ability to enhance the activity of the sympathetic-adrenal system, which aggravates the course of the underlying disease. Given this feature, diuretic therapy should be used with simultaneous administration of drugs that reduce neurohumoral activation (Enalapril 10 mg in the morning orally).
As first-line drugs, with patient signs of heart cough as one of the criteria for heart failure, loop diuretics are used (Furosemide, Etakrinaic acid). However, recently the World Association of Cardiologists has issued new recommendations, according to which a moderate-intensity heart cough is well treatable with thiazide diuretics. Diuretics of the potassium-sparing group for the treatment of cardiac cough are extremely rare.
When considering the selection of an adequate diuretic prescription, the severity of the patient's condition should be taken into account. With moderate manifestations of cardiac cough, it is recommended to use one medication in the morning at the lowest effective dose, which is 20 mg for Furosemide, 25 mg Hydrochlorothiazide, Torasemide 10 mg, Etracinic acid 25 mg. As a rule, this dosage of drugs is sufficient for the normalization of the patient suffering from excruciating attacks of cardiac cough.
As an additional non-pharmacological treatment, which is rarely used in isolation, however, it is effective in controlling respiratory disorders in patients suffering from heart failure, oxygen therapy. The use of oxygen therapy can significantly improve the patient's quality of life by reducing the painful sensation of dyspnea, improving sleep, increasing physical activity.
? Cardiac cough - which doctor will help ? If there is or suspected the development of a cardiac cough, you should immediately seek advice from such doctors as a cardiologist and / or rheumatologist.