Cough of cardiovascular origin (Cardiac cough)

Specialty: Cardiovascular.

• congestive cough due to heart failure
• pulmonary stasis cough
• cough equivalent of dyspnea

Why it occurs

• Interstitial pulmonary edema due to acute or chronic left ventricular failure
• Narrow mitral stenosis with pulmonary venocapillary hypertension
• Cough secondary to the use of ACEI drugs (cough due to accumulation of bradykinins in the airway)
• Congestive heart failure with reflex bronchospasm (cardiac asthma)
• Aortic arch aneurysm with compression of the recurrent laryngeal nerve or left main bronchus

Initial workup

Determination of serum B-type natriuretic peptide (BNP) or NT-proBNP; Transthoracic Doppler echocardiogram to evaluate left ventricular systolic function, left atrial size, evaluate mitral/aortic valve disease, and estimate left ventricular diastolic pressure; Chest x-ray in posteroanterior and lateral projections to detect signs of alveolar or interstitial fluid congestion, cephalization of flows and cissural effusion; Spirometry if differential diagnosis with asthma or COPD is required.

Standard management

• Furosemide — first choice loop diuretic for the management of volume overload and pulmonary venocapillary hypertension; 40 mg intravenous initial bolus, repeatable according to fluid balance
• Losartan — angiotensin II receptor antagonist indicated if the cough is secondary to the use of ACE inhibitors, allowing neurohormonal blockade to be maintained without inducing bradykinin accumulation; 50 to 100 mg once daily orally
• Carvedilol — beta blocker indicated in stable chronic heart failure once the acute condition has been overcome; starting with 3,125 mg twice daily with progressive titration
• Empagliflozin (SGLT2i indicated in systolic or diastolic heart failure to reduce extracellular volume; 10 mg once daily orally).