Introduction

Wheezing is when you have a whistling and high-pitched sound you make when you breathe which usually indicates that there is either inflammation in your airways or they are narrowed.¹ It is a common respiratory symptom commonly caused by chronic obstructive pulmonary disease, asthma, allergies, respiratory infections and so on.² However, identifying the exact cause of wheezing presents its own challenges due to the diverse range of potential causes. 

If you are suffering from heart failure or heart disease, controlling your wheezing becomes significantly important and complex due to the overlapping symptoms such as chest tightness, fatigue and shortness of breath.² In addition to that, your doctor may have prescribed you certain medications for your heart disease, common ones include ACE inhibitor or beta blocker; which may affect your respiratory function either worsening or inhibiting your respiratory symptoms.³ The need for caution with medication sensitivities in these patients further complicates treatment, as some respiratory medications may interact with cardiac drugs, potentially worsening heart-related issues. Therefore, a comprehensive and considered approach is essential to accurately identify and manage wheezing in patients with cardiac comorbidities.

Understanding wheezing in heart disease and heart failure

Wheezing is caused as a result of your airways narrowing which makes it harder for the air to pass through.¹ The narrowing can be due to different reasons, such as excess mucus, inflammation, and muscle spasms. In addition to these reasons for airway narrowing which is related to lung-related diseases, wheezing can have a more complex root cause.² If you have heart disease, wheezing can be due to blood flow or blood buildup.

How heart disease can lead to wheezing

Heart disease, particularly heart failure, leads to wheezing because the heart can not pump blood efficiently so fluid starts building up in the lungs causing congestion, which is usually referred to as “cardiac asthma”.⁴ However, don't be fooled by the word asthma. Asthma is caused by a different mechanism but they have overlapping symptoms.

Another reason you might experience wheezing if you have heart disease can be due to reduced oxygenation and impaired blood flow. This means that when you have heart problems and the efficiency of your blood flow is compromised, your lungs will not get enough oxygen which can make your airways tighten.⁵ Hence you will experience difficulty in breathing that sometimes can lead to wheezing, especially during physical activity. 

To conclude, wheezing is often assumed to be due to lung problems, but it can also be an indication of heart problems. Therefore, if you have heart problems and experience wheezing, you need to consider the bigger picture and focus on how to improve your heart function. 

Diagnostic approach

If you have a history of heart disease, understanding the root cause of your wheezing needs to be as accurate as possible. Because heart and lung disease can present similar symptoms but different causes, therefore, accurate diagnosis, can allow accurate treatment.

Many techniques and tools are used for diagnosing you. If you have heart problems, an echocardiogram is a common test used to assess how well your heart is pumping. This test can show your heart valve issues or fluid buildup.³ On the other hand, if the cause of your wheezing is lung problems, you will probably do a chest X-ray and/or pulmonary function tests (PFTs) to assess fluid in your lungs, potential infections, structural abnormalities and the overall function.⁴

Treatment and management strategies

Pharmacological interventions

If you have heart disease and are suffering from respiratory symptoms at the same time, your medications should be carefully monitored. This is because some medications used to treat your heart disease can worsen your respiratory symptoms, such as beta blockers and ACE inhibitors.⁴ This can result in your wheezing being mistaken as caused by respiratory issues, but,  these might simply be side effects of your medication. On the other hand, medications to address your respiratory symptoms such as wheezing could potentially worsen your heart condition. An example of these is both bronchodialators or corticosteroids that can increase heart rate.⁶ Therefore, it is important to be able to find the right balance of your pharmacological interventions where both the heart and lungs are supported without additional causing harm to either system.

Fluid overload treatment

As mentioned before, the underlying reason for your wheezing if you have heart disease, is fluid buildup in your lungs. Therefore, a way to treat your wheezing is to eliminate excess fluid in your lungs which can reduce lung congestion.⁷ The most common way to do that is using diuretics, which when taking them, you might also be advised to reduce your fluid and salt intake to prevent additional fluid accumulation. 

Oxygen therapy

If you have suffered from heart failure, your wheezing is most likely due to low oxygen levels. Therefore, supplemental oxygen can be highly effective by improving your blood oxygenation and decreasing the feeling of breathlessness.⁸ Supplemental oxygen needs to be carefully monitored, as excess oxygen can cause severe side effects. 

Lifestyle and supportive interventions

To manage your wheezing and respiratory symptoms especially if you have heart disease, certain lifestyle interventions are crucial:

1. Adopt a low sodium diet: managing your salt intake can reduce fluid retention in your lungs⁹
2. Exercise: Low-impact activities can improve your respiratory and cardiovascular functions such as walking, swimming, cycling
3. Patient education: it is important for you to have the knowledge of your conditions and symptoms. This will allow you to recognise early signs of fluid buildup or worsening wheezing which can help you prevent complications

Summary

If you are suffering from heart disease you might experience respiratory symptoms such as wheezing. The underlying cause is usually fluid buildup as the heart is struggling to pump efficiently. However, if you suffer from heart failure, your wheezing is likely because not enough oxygen is being delivered to your lungs, causing you to feel breathless. 

To manage wheezing, you can try pharmacological treatments. However, you should be aware that these medications can lead to increased heart rate which will cause complications for your heart disease. On the other hand, you should also be aware that many of the common heart disease medications can cause respiratory symptoms such as wheezing. Therefore, is it important for you to find the correct balance of your medications so that they don’t cause harm to your heart and lungs. 

Other lines of treatment focus on limiting fluid overload or increasing oxygen in your lungs. In addition to these treatment methods, modifications to your lifestyles are also important to reduce fluid retention and improving your lung and heart function.