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What Causes Shortness Of Breath And Cough?
Question: My mother was recently hospitalized in a reputed heart hospital due to short of breath and cough. Cardiologist informed us that the oxygen is not properly supplied to the body due to LV dysfunction and fluid retention is there which need to be reduced. She was discharged after four days of treatment. The discharge summary is as follows
Diagnosis - Severe LV Dysfunction, Moderate MR, Type 2 Diabetes Mellitus
BP 110/70, PR 90 bpm, CVS S1 S2 + Heard, RS NVBS, GIT P/A Soft, CNS No FND
Course in the Hospital – Patient was admitted with complaints of cough and suffocation. Patient was treated with diuretics, insulin and other supportive measures.
Echo – Septum, Inferior wall, anterior wall akinetic, Severe LV systolic dysfunction, Grade 3 MR, Trivial AR, No PAH
She has been taking below medicines
Glynase MF + Vozuca 0.2 + Valent 80+ Zytanix 5 + Dytor 20 +Clodrel – (Clopidogre 75mg) + Atrap 20 (Adorvastatin ) + Aldactone (Spironolactone) + Pantocid DSR (Enteric Coated Pantoprazole Sodium and Sustained Release Domperidone) + Thyronorm 100 mg
Her lab results (recent) Serum Sodium – 139 mmol/L & Potssium – 3.8 mmol/L, Calcium – 8.9 mg/dl, Creatinine – 0.82 mg/dl, Blood Urea – 21 mg/dl, Troponin T – Negative, CRP – 1.8 mg/L, Haemoglobin – 11.6 gms%, TSH – 6.15IU/mlUrine Sugar – Nil, Reaction – Acidic, Albumin – Present
Now she has been coughing at night. Daytime is ok. It would sometime worse, that is she would vomit. Her sleeping became a nightmare. What could be the reason? Would appreciate if you could suggest any medicine for getting rid-off this cough. Also please suggest to whom (specialist) we can consult other than a Cardiologist
Diagnosis - Severe LV Dysfunction, Moderate MR, Type 2 Diabetes Mellitus
BP 110/70, PR 90 bpm, CVS S1 S2 + Heard, RS NVBS, GIT P/A Soft, CNS No FND
Course in the Hospital – Patient was admitted with complaints of cough and suffocation. Patient was treated with diuretics, insulin and other supportive measures.
Echo – Septum, Inferior wall, anterior wall akinetic, Severe LV systolic dysfunction, Grade 3 MR, Trivial AR, No PAH
She has been taking below medicines
Glynase MF + Vozuca 0.2 + Valent 80+ Zytanix 5 + Dytor 20 +Clodrel – (Clopidogre 75mg) + Atrap 20 (Adorvastatin ) + Aldactone (Spironolactone) + Pantocid DSR (Enteric Coated Pantoprazole Sodium and Sustained Release Domperidone) + Thyronorm 100 mg
Her lab results (recent) Serum Sodium – 139 mmol/L & Potssium – 3.8 mmol/L, Calcium – 8.9 mg/dl, Creatinine – 0.82 mg/dl, Blood Urea – 21 mg/dl, Troponin T – Negative, CRP – 1.8 mg/L, Haemoglobin – 11.6 gms%, TSH – 6.15IU/mlUrine Sugar – Nil, Reaction – Acidic, Albumin – Present
Now she has been coughing at night. Daytime is ok. It would sometime worse, that is she would vomit. Her sleeping became a nightmare. What could be the reason? Would appreciate if you could suggest any medicine for getting rid-off this cough. Also please suggest to whom (specialist) we can consult other than a Cardiologist
Brief Answer:
Worsening heart failure or lung disorder
Detailed Answer:
Dear Sir
There are two main possibilities among many possible causes for such a scenario.
1. It is the worsening heart failure which causes more symptoms on lying down. This may result in shortness of breath and cough on lying down. It gets somewhat better on sitting or standing. This occurs typically after 2-3 hours of sleep but may occur much earlier. Keeping 2-3 pillows or raising head end of bed will help symptomatically. the cardiologist need to revise her medication by possibly changing dose of diuretics and ARBs/ ACE inhibitors. Reduction in salt intake may also help. Uncommonly, the drugs like Valent may be responsible for cough. This will require possible change of brand/ agent by your cardiologist.
2. Second possibility is of lung infection. It is common in both old age and heart failure. This may result in incessant cough.
Both these conditions need assessment by respective physician on priority. Cardiologist as well as pulmonologist.
sincerely
sukhvinder
Worsening heart failure or lung disorder
Detailed Answer:
Dear Sir
There are two main possibilities among many possible causes for such a scenario.
1. It is the worsening heart failure which causes more symptoms on lying down. This may result in shortness of breath and cough on lying down. It gets somewhat better on sitting or standing. This occurs typically after 2-3 hours of sleep but may occur much earlier. Keeping 2-3 pillows or raising head end of bed will help symptomatically. the cardiologist need to revise her medication by possibly changing dose of diuretics and ARBs/ ACE inhibitors. Reduction in salt intake may also help. Uncommonly, the drugs like Valent may be responsible for cough. This will require possible change of brand/ agent by your cardiologist.
2. Second possibility is of lung infection. It is common in both old age and heart failure. This may result in incessant cough.
Both these conditions need assessment by respective physician on priority. Cardiologist as well as pulmonologist.
sincerely
sukhvinder
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Sir,
Thank you for your reply. She was earlier taking Coversyl 4mg. When we visited the Cardiologist last time (28/August) this tablet was replaced (due to dry cough) to Valent 80. Sir, kindly advise me on what symptoms, should I be more vigilant? Or take her to the hospital? After studying her history, what do you think about her future life? At current circumstances, will these cause any life threatening to her? I humbly request you to guide me further course of action
Thank you for your reply. She was earlier taking Coversyl 4mg. When we visited the Cardiologist last time (28/August) this tablet was replaced (due to dry cough) to Valent 80. Sir, kindly advise me on what symptoms, should I be more vigilant? Or take her to the hospital? After studying her history, what do you think about her future life? At current circumstances, will these cause any life threatening to her? I humbly request you to guide me further course of action
Brief Answer:
Please see details.
Detailed Answer:
Dear Sir
1. Yes, drugs like Coversyl are known to be associated with dry cough and Valent like drugs are associated with cough uncommonly. But it will not be so that such a cough comes up only at night and not in day. A nocturnal cough is a symptom enough to get evaluation by the cardiologist especially if it is associated with shortness of breath. Hence she should be reevaluated by the cardiologist on priority.
2. Severe Systolic dysfunction is a condition which is associated with considerable morbidity and mortality. However this statement is not without riders. The cause of low pumping, the status of coronary arteries and symptoms are some of confounding factors. Yes, there can be life threatening events in some of these patients. However a proportion of them may improve considerable with medical therapy. Some of them are candidates of therapies directed at opening the arteries. They respond well to opening the blocked arteries. Details of these can be best elaborated by her treating cardiologist.
3. Avoid excessive salt intake, provide her bed rest and elevate head-end of bed for a possible help in her cough.
4. Increase in breathing rate, breathlessness, increase in weight (measured on daily basis), decrease urine output and easy fatiguability are some of alarming symptoms.
sincerely
Sukhvinder
Please see details.
Detailed Answer:
Dear Sir
1. Yes, drugs like Coversyl are known to be associated with dry cough and Valent like drugs are associated with cough uncommonly. But it will not be so that such a cough comes up only at night and not in day. A nocturnal cough is a symptom enough to get evaluation by the cardiologist especially if it is associated with shortness of breath. Hence she should be reevaluated by the cardiologist on priority.
2. Severe Systolic dysfunction is a condition which is associated with considerable morbidity and mortality. However this statement is not without riders. The cause of low pumping, the status of coronary arteries and symptoms are some of confounding factors. Yes, there can be life threatening events in some of these patients. However a proportion of them may improve considerable with medical therapy. Some of them are candidates of therapies directed at opening the arteries. They respond well to opening the blocked arteries. Details of these can be best elaborated by her treating cardiologist.
3. Avoid excessive salt intake, provide her bed rest and elevate head-end of bed for a possible help in her cough.
4. Increase in breathing rate, breathlessness, increase in weight (measured on daily basis), decrease urine output and easy fatiguability are some of alarming symptoms.
sincerely
Sukhvinder
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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