See if you could see my face right now, you'd be seeing a very wide, sarcastic smile....
Chronic cough's are a bit of a specialty for me as it's the first thing that "got" me into this mess and it's been with me ever sense.
First off, a few clarifications are in order:
Chronic heart failure is defined as the inability of the heart to pump as efficiently as it's supposed to. That's it. The levels of heart failure are determined by the symptoms and generally (depending on the sort of doctor you talk to) if you have a heart condition, you are in some form of heart failure, always. The most minor form shows almost no outside signs or symptoms. If you show a slightly enlarged heart on an x-ray, you're in heart failure, but only because one of (usually left as I recall) your ventricles is bigger than usual. Beyond that, the next few signs to show up are (drum roll please...) fluid retention in the lungs and or extremeties. Fluid in the lungs causes a chronic cough.
I won't get into the rest of the symtoms unless someone wants me to. You can look 'em up on-line failry easy.
The other possible side-effect of an enlarged heart is in the pressure it may be putting on a bundle of nerves located at the base of the bronchial tubes where they split to deliver air to the lungs when you breath. The bundle branch (I've forgotten the specific term) is sensitive to the touch and it's possible that the enlarged heart may actually be pushing up against the bundle, especially when it's pumping hard during exercise, causing a cough reflex.
Then you got your other causes: side-effects of medications like lisinopril and a few other ACE inhibitors, acid reflux (who all is on Prilosec???) can cause a chronic cough too.
The difficulty that my doctors and I have been having is in tracking down what's most likely MULTIPLE causes for the same stupid and annoying cough. For a while it was quite clear that it was CHF, but then it would go away and come back. Before surgery I coughed nearly ALL the time, it was debilitating and probably one of the worse experiences I've had in the entire process of recieving an artificial heart valve (that I can remember anyways.)
After surgery, it went away a LOT, but it was still there and it VERY slowly got worse again until we started tracking down the possiblity of an acid reflux problem. Now, my cough is most prominent in the mornings after I get up out of bed, but not ALWAYS there and not always with the same intensity. On occassion, it will also come up at night or in the afternoons. I've also noticed some correlations between the cough and very salty foods or even just eating a lot more than usual in a meal.
One last thought on diuretics (mind you, I'm not a doctor and I don't play one on TV.) Generally, I stay close to the same dose at the same time for my diuretics every day. I take 60mg in the morning, 60mg and night, whether I "feel" like I need it or not. Sometimes I DO feel like I'm overloading on fluids and my doctor's given me permission to go ahead and either take an additional 40mg same mid-afternoon or later at night, or take 80mg instead of 60mg at dinner time. I don't do that often and it's usually when I haven't been able to avoid really salty foods without starving myself...
Just saying.
