Coughing After Lying Down in Patients with AICD

Primary Cardiac Causes

Heart failure is a common condition in patients with AICDs and can cause coughing, particularly when lying down, as fluid redistribution increases pulmonary congestion 1
Pulmonary edema, whether cardiogenic or noncardiogenic, can cause cough that may be the sole presenting manifestation of congestive heart failure 3
Patients with heart failure often experience worsening of symptoms in the supine position due to increased venous return and subsequent pulmonary congestion 2

ACE inhibitors, commonly prescribed for heart failure patients with AICDs, can cause a persistent dry cough in approximately 5-10% of white patients and up to 50% in Chinese patients 2
The American College of Cardiology recommends considering alternative medications, such as angiotensin receptor blockers (ARBs), if ACE inhibitor-induced cough is suspected 2

The AICD device itself may cause mechanical irritation to surrounding tissues, particularly when the patient is lying down, potentially triggering a cough reflex 3, 4
Mediastinal lesions or devices (like an AICD) may impinge on adjacent airways and lead to chronic cough, especially in certain positions 3

Interstitial lung disease, which can be present in patients with cardiac conditions, may cause chronic cough that can be exacerbated by position changes 5, 6

The American Heart Association recommends assessing for progression of underlying heart failure, including checking for other signs of fluid overload 1, 2
Reviewing medication lists for ACE inhibitors and considering a trial of discontinuation if appropriate is recommended by the American College of Cardiology 2
Chest imaging may be considered to evaluate for pulmonary edema, interstitial changes, or device-related complications, as suggested by the American Thoracic Society 5, 6

Optimizing heart failure therapy to reduce pulmonary congestion, which may resolve positional cough, is recommended by the American College of Cardiology 1, 2
If ACE inhibitor-induced cough is suspected, considering switching to an angiotensin receptor blocker (ARB) is recommended by the American Heart Association 2
For persistent cough despite addressing cardiac causes, considering treatments for unexplained chronic cough according to guidelines, such as gabapentin or speech pathology therapy, is suggested by the American Thoracic Society 6

The American College of Cardiology advises against assuming cough is always due to the AICD itself; underlying heart failure is a more common and potentially serious cause 1, 2
Avoid attributing cough solely to ACE inhibitors without first ruling out worsening heart failure, as recommended by the American Heart Association 2
Be cautious with supplemental oxygen therapy in patients with heart failure and cough, as it may mask hypoventilation without treating the underlying cause, as warned by the American Thoracic Society 8