Think Twice: Cough During a Heart Attack
Don’t believe everything you read, especially when it comes to you via a forwarded email. A report that coughing can save your life during a heart attack spread rapidly this way, and is now widely believed. But just like those emails from Nigeria saying you’ve inherited a large sum of money, it’s a case of “too good to be true.”
Health experts say the technique, known as cough CPR, is unlikely to help at best, and dangerous at worst. Cough CPR has been used in controlled hospital settings to treat sudden life-threatening arrhythmias (abnormal heart rhythms). By coughing vigorously and repeatedly, the patient may be able to force enough blood to the brain to help him stay conscious long enough for the heart to regain its natural rhythm. Coughing will not help all types of arrhythmias, and may make some worse. Besides, many heart attacks do not result in an arrhythmia. For these reasons, the American Heart Association (AHA) says cough CPR is unlikely to help most heart attack victims and should not be routinely taught.
In 2003, Polish physician Tadeusz Petelenz claimed that patients at high risk of cardiac arrest could be trained to recognize symptoms and use a coughing technique to keep themselves conscious until help arrived. It should be noted that cardiac arrest, where the heart stops beating, is not the same thing as a heart attack, which involves a lack of blood flow to the heart. According to Petelenz, in his study of 115 patients, symptoms disappeared in 80% of the situations where cough CPR was used.
Many experts in the field said Petelenz’ study lacked critical evidence, including whether his patients were actually in cardiac arrest at the time the technique was used. They also questioned whether patients would be able to initiate cough CPR once their heart stopped, after which they have roughly 10 to 15 seconds before passing out. Cough CPR requires patients to cough 10 to 30 times, every two to three seconds. That doesn’t give someone who is in the middle of cardiac arrest much time to react and begin treatment.
Despite these criticisms, the technique is regarded as potentially useful in hospital settings, when doctors anticipate the event and can coach their patient through it. Cough CPR should only be used for cardiac arrests caused by arrhythmias, and only if the patient is about to lose consciousness. The technique will not likely help a heart attack, which occurs when blood flow to the heart is disrupted.
The AHA and other heart organizations say the technique should be limited to doctor-supervised hospital situations, such as cardiac catheterization, where arrhythmias have been treated successfully with “cough CPR” under close supervision. They warn that coughing could make things worse if a person is having a heart attack.
For the rest of us, our best defense is to learn the warning signs of a heart attack and immediately call for emergency help. Heart attack warning signs may include chest pain (sometimes radiating to the arm, neck, back, jaw or belly), shortness of breath, nausea, sweating and lightheadedness.
Bottom Line: If you think you’re having a heart attack or cardiac arrest, forget the cough. Some strong claims have been made for “cough CPR,” but most experts oppose its use. Instead, dial 911. Once you’ve called for help, if you can, chew and swallow 325mg of non-enteric-coated aspirin.