How to survive a heart attack

May 11, 2004

At 02:24 AM 5/11/2004, Margaret wrote:

>TO SURVIVE A HEART ATTACK

> If everyone who gets this sends it to 10 people, you

> can bet that we'll save at least one life.

From http://www.snopes.com/toxins/coughcpr.htm

Claim: Doctors generally recommend that one attempt to rhythmically cough

during a heart attack to increase the chance of surviving it.

Status: False.

Example: [Collected on the Internet, 1999]

Origins:

This helpful e-mail began its life on the Internet in June 1999. Those

kindhearted souls who started it on its way likely had no inkling the

advice they were forwarding could potentially be harmful to someone

undergoing a heart attack, but that is indeed the case.

If you knew exactly what you were doing, this procedure it might help save

your life. If, however, you were to attempt cough CPR at the wrong time

(because you misjudged the kind of cardiac event being experienced) or went

about it in the wrong way, it could make matters worse.

Cough CPR is not a new procedure — it has been around for years and has

been used successfully in isolated emergency cases where victims realized

they were on the verge of fainting and about to go into full cardiac arrest

(their hearts were about to stop) and knew exactly how to cough so as to

keep enough oxygen-enriched blood circulating to prevent them from losing

consciousness until help could be sought, or they were under the direct

care of physicians who recognized the crises as they were taking place and

were on hand to instruct patients step by step through the coughing. Even

were the afflicted to correctly recognize they were experiencing the sort

of cardiac event where cough CPR could help, without specific training to

hit the right rhythms their coughing could turn mild heart attacks into

fatal ones.

This is not to say cough CPR couldn't be effectively taught to patients

deemed at risk of further heart attacks. According to a widely circulated

news report surfacing in September 2003, a doctor in Poland has been

attempting exactly that. Dr. Tadeusz Petelenz of the Silesian Medical

Academy in Katowice Province claims to have successfully instructed a

number of his patients in the procedure, but it should be noted his results

have not been independently confirmed. While a September 2003 Reuters

article detailed the Polish doctor's championing of cough CPR, a similar

Associated Press report on the same subject noted that " Experts said while

the concept is provocative, it needs more study " and that " Dr. Marten

Rosenquist, professor of cardiology at the Karolinska Institute in

Stockholm, Sweden, and an expert in heart beat abnormalities, said the

concept is interesting but that Petelenz showed no evidence his patients

actually had arrhythmias. "

It is unclear from the news reports whether the Polish heart patients who

supposedly experienced success with cough CPR were doing so under strict

medical supervision in a hospital or were going about their private lives

at the time of the cardiac events that prompted them to attempt the

procedure. It is one thing for success to be achieved in a hospital setting

where patients know intervention will swiftly follow if problems are

encountered, and quite another when patients are in unscripted settings (at

home, at work, or while driving in a car). Would such instruction hold up

in field conditions, where those about to go into full cardiac arrest know

there's no net under the tightrope?

Yet even if cough CPR can be effectively taught by physicians, it's not

going to be learned from an e-mail, at least not well enough to be safe.

Even if Dr. Petelenz's findings prove out, there's a wide (and dangerous)

gap between in-person one-on-one training by a professional on hand to

quickly correct a patient's mistakes before they become habit and generic

printed instruction wholly lacking in direct feedback and guidance.

Thinking one is a valid substitute for the other would be akin to believing

studying a typed set of instructions is all it takes to learn how to drive

a car well enough to take it down the freeway and back.

The e-mailed advice about coughing during a heart attack leaves the

impression the " cough CPR " technique is endorsed by Rochester General

Hospital and Mended Hearts. Rochester General had nothing to do with any of

this — how its name came to be attached to this message is a mystery. See

their web page which denies their having endorsed this e-mail

Mended Hearts (a support group for heart disease patients and their

families) is not nearly so blameless.

Although the text of the e-mailed advice was published in a Mended Hearts

newsletter, the organization has since disavowed it and for a time had a

page on its web site asking readers not to take the e-mail seriously

because they didn't stand behind it. The piece on cough CPR found its way

into that publication through a blend of too much enthusiasm and a dearth

of fact checking. From there, other chapters picked it up, spreading the

notion to an even wider audience. Attempts now to distance the organization

from it don't begin to undo the damage done by the piece having been picked

up from there.

Darla Bonham, Mended Heart's executive director, has since issued a

statement about cough CPR:

I've received email from people all across the country wanting to know if

it is a valid medically approved procedure. I contacted a scientist on

staff with the American Heart Association Emergency Cardiac Care division,

and he was able to track a possible source of the information. The

information comes from a professional textbook on emergency cardiac care.

This procedure is also known as " cough CPR " and is used in emergency

situations by professional staff. The American Heart Association does not

recommend that the public use this method in a situation where there is no

medical supervision.

Dr. Richard O. Cummins, Seattle's director of emergency cardiac care,

explains that cough CPR raises the pressure in the chest just enough to

maintain some circulation of oxygen-containing blood and help enough get to

the brain to maintain consciousness for a prolonged period. But cough CPR

should be used only by a person about to lose consciousness, an indication

of cardiac arrest, he cautions. It can be dangerous for someone having a

heart attack that does not result in cardiac arrest. Such a person should

call for help and then sit quietly until help arrives, he says.

In other words, the procedure might be the right thing to attempt or it

might be the very thing that would kill the afflicted depending on which

sort of cardiac crisis is being experienced. Without a doctor there to

judge the situation and, if cough CPR is indicated, to supervise the

rhythmic coughing, the procedure is just far too risky for a layman to

attempt.

Forget about coughing — key to surviving a heart attack is obtaining proper

medical assistance within a very limited window of opportunity. Once an

acute myocardial infarction (AMI) has been diagnosed, speedy injection of

thrombolytic agents to dissolve clots is of the utmost importance — the

more quickly those drugs are delivered, the better the chances of survival

are. It's a race against the clock.

Most patients who present with minor chest pains usually look healthy and

show no signs of a heart attack. Electrocardiogram (ECG) results tell the

story though, so be sure to insist upon one being performed if you've any

doubts at all. Often mild heart attacks are left untreated and undetected

because hospital staff mistake a heart attack for something more benign

because the presenting symptoms are minor.

Rather than risk killing yourself with cough CPR, those experiencing a

heart attack should heed the advice of physicians the world over — down a

couple of Aspirin as an emergency remedy. Doctors believe that during the

early stages of a heart attack, Aspirin — which is known to prevent blood

platelets from sticking together — can prevent a clot from getting bigger.

In 1991 Dr. Michael Vance, president of the American Board of Emergency

Medicine, recommended that people who think they are having a heart attack

should " Call 911, then take an Aspirin. "

Oh, and it probably makes a great deal of sense to chew the Aspirin before

swallowing. The sooner it is dispersed by the stomach, the sooner it gets

to where it is needed. During a heart attack, waiting for the enteric

coating surrounding the pill to break down naturally could be a mistake.

In 1993 The American Heart Association began recommending a 325 mg Aspirin

at the onset of chest pain or other symptoms of a severe heart attack. That

bit of advice is going unheeded though — a follow-up report published in

1997 shows as many as 10,000 American lives a year could be saved if more

people who think they're having a heart attack took an aspirin at the start

of chest pains.

In terms of the drama of it, swallowing an Aspirin seems quite a come-down

from bravely trying to induce a perfectly timed coughing fit. Less

flamboyant is better, though; Aspirin saves lives, whereas coughing might

well cost them.

Barbara " from coughing to coffin? " Mikkelson

Additional information: Cough CPR

(Red Cross)

Cough CPR

(American Heart Association)

Heart Attack Treatments

(American Medical Association)

Heart Attack information

(American Heart Association)

Last updated: 2 September 2003

May 11, 2004

There may or may not be something to this. I'm not sure.

Kel

Margaret <me.chalkley wrote:

"Margaret" Tue, 11 May 2004 07:24:57 +0100 Fw: Fw: Fw: How to survive a heart attackTO SURVIVE A HEART ATTACKIf everyone who gets this sends it to 10 people, you can bet that we'll save at least one life. Let's say it's 6:15 p.m. and you're driving home (alone of course), after an unusually hard day on the job. You're really tired, upset and frustrated. Suddenly, you start experiencing severe pain in your chest that starts to radiate out into your arm and up into your jaw. You are only about five miles from the hospital nearest your home; unfortunately you don't know if you'll be able to make it that far. What can you do? You've been trained in CPR but the guy that taught the

course neglected to tell you how to perform it on yourself. Since many people are alone when they suffer a heart attack, this article seemed to be in order. Without help, the person whose heart stops beating properly and who begins to feel faint, has only about 10 seconds left before losing consciousness. However, these victims can help themselves by coughing repeatedly and very vigorously. A deep breath should be taken before each cough. The cough must be deep and prolonged, as when producing sputum from deep inside the chest. And a cough must be repeated about every 2 seconds without let up until help arrives, or until the heart is felt to be beating normally again. Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating. The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can get to a hospital. Tell as

many other people as possible about this, it could save their lives! From Health Cares, Rochester General Hospital via Chapter 240s newsletter AND THE BEAT GOES ON ... (reprint from The Mended Hearts, Inc. publication, Heart Response)