Not Just Asthma: Wheezing And Coughing May Signal Heart Failure, Doctor Warns

Wheezing, persistent coughing and shortness of breath are symptoms commonly associated with asthma, but they can sometimes indicate an underlying heart problem. A condition often referred to as “cardiac asthma” can produce similar breathing difficulties when heart failure causes fluid to accumulate in the lungs and airways. Dr Binay Kumar, Director of Interventional Cardiology and Electrophysiology at Yatharth Super Speciality Hospital, Sector 88, Faridabad, explained that cardiac asthma is not actually a form of asthma. Instead, it describes breathing difficulty caused by heart failure, particularly when the left side of the heart is unable to pump blood effectively.

“Cardiac asthma is not a type of asthma; it’s an episode of breathing difficulty as a result of heart failure,” Dr Kumar said. He explained that left-sided heart failure can cause congestion in the lungs, making breathing problems more noticeable when a person lies down, particularly at night. When the heart's left side becomes weak, blood can build up in the circulation leading to the lungs. This increased pressure can cause fluid to move into lung tissue and the airways. As a result, a person may develop symptoms such as wheezing, coughing and breathlessness that can resemble those caused by conventional asthma.

Dr Kumar said these symptoms can occur even in people experiencing relatively low-grade heart failure. “In people who have heart problems and go into heart failure, even low-grade heart failure, there’s fluid that gets into the lungs and fluid that gets into the airway,” he explained. The resulting symptoms may therefore be related to the heart rather than an underlying airway disorder. One feature that can provide an important clue is worsening breathlessness after lying down. People with heart failure may find it difficult to breathe comfortably at night or may need to sit or use additional pillows to sleep. However, breathing problems can have many causes, and these symptoms alone cannot establish whether a person has heart failure.

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The distinction between asthma and heart-related breathing problems is important because the underlying causes and treatments are different. Asthma primarily involves inflammation and narrowing of the airways, while cardiac asthma results from the effects of impaired heart function and fluid accumulation in the lungs. Doctors may use a combination of medical history, physical examination and diagnostic tests to determine the cause of breathing difficulties. Depending on the suspected condition, evaluation may include heart imaging, an electrocardiogram, blood tests and assessment of lung function. People with known heart disease who develop new or worsening wheezing, coughing or breathlessness should not automatically assume that the symptoms are asthma.

A medical evaluation can help determine whether the symptoms are related to the heart, lungs or another condition. Severe or sudden breathlessness, particularly when accompanied by chest discomfort, fainting, confusion or a rapid deterioration in symptoms, requires urgent medical attention. Heart failure can become serious when fluid accumulation in the lungs significantly interferes with breathing. Recognising that heart problems can sometimes resemble respiratory conditions may help patients seek the appropriate evaluation sooner. As Dr Kumar's explanation highlights, wheezing and breathlessness are not always caused by asthma, and symptoms that worsen when lying down can warrant assessment for an underlying cardiac cause.

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