Heart attack victims shouldn’t use “cough CPR” on themselves, contrary to chain email dating back to 1999
A heart attack occurs when a person’s heart muscle doesn’t receive enough blood. If a person shows signs of a heart attack, they should contact emergency services before doing anything else. In a minority of heart attack cases, cardiopulmonary resuscitation (CPR) or an electrical shock (defibrillation) is needed when the heart stops pumping (cardiac arrest). The method known as “cough CPR” shouldn’t be used without medical supervision, as it can lead to more harm than good.
Inaccurate: Contrary to the post’s claim, medical professionals warn untrained individuals against using “cough CPR” in the event of a heart attack, as it is more likely to harm than help. “Cough CPR” should only be used under medical supervision.
A Facebook post published in 2013 that went viral on Facebook in March 2021, titled “How to survive a heart attack alone”, claimed that heart attack victims “can help themselves by coughing repeatedly and very vigorously. A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest.”
The advice given in the post began circulating as early as 1999, as a Snopes fact-check published in the same year reported. Although this method, commonly termed “cough CPR”, has been used in medical settings for certain heart conditions, its use on people suffering from a heart attack is likely to produce more harm than good, as this review explains below.
According to the U.S. Centers for Disease Control and Prevention (CDC), a heart attack occurs when “a part of the heart muscle doesn’t get enough blood”. The CDC added that “In some cases, a heart attack requires cardiopulmonary resuscitation (CPR) or an electrical shock (defibrillation) to the heart to get the heart pumping again”. This is because a heart attack can result in an abnormal heart rhythm, also known as arrhythmia, and lead the heart to stop pumping.
“Forceful coughing increases pressure in the chest, which helps maintain blood flow. A conscious, responsive person, by coughing forcefully and repetitively, might be able to keep enough blood flowing to the brain to remain conscious for a minute or two until the arrhythmia is treated”.
He also added that “doctors sometimes ask their patients to cough if an arrhythmia—particularly a slow heart rate—occurs during a heart catheterization”.
“We would occasionally see that in the intensive care unit or in a cardiac catheterization lab someone would go into a ventricular arrhythmia [an abnormal heartbeat originating in the lower heart chambers] or supraventricular arrhythmia [a fast heartbeat beginning above the heart’s two lower chambers] […] And when we tell the patient to cough really hard that could terminate the rhythm.”
However, most heart attacks don’t lead to arrhythmia, Bhatt pointed out. As such, “coughing would not make any difference”, he said.
The Resuscitation Council U.K., which sets the national standards for cardiopulmonary resuscitation (CPR) in the U.K., stated that CPR “is the correct treatment for sudden cardiac arrest, which is when the heart suddenly stops pumping”. However, “the majority of people having a heart attack will not suffer a cardiac arrest, and by attempting ‘cough CPR’ they could make their condition worse”.
The American Heart Foundation also stated that “‘Cough CPR’ may be a temporary measure in settings such as the cardiac catheterization laboratory where patients are conscious and constantly monitored (for example, with an ECG machine). A nurse or physician can instruct and coach the patients to cough forcefully every one to three seconds during the initial seconds of a sudden arrhythmia”.
Overall, the advice given in the Facebook post and republished in various iterations across the Internet appears to have arisen by inaccurately conflating a heart attack with an arrhythmia. As the above demonstrates, the “cough CPR” method should only be used in cases where a person has certain types of arrhythmias, which only occur in a minority of heart attack cases.
And more importantly, “cough CPR” should only be used when a patient is under medical supervision and can be instructed to perform the method correctly. Therefore, it is not an ideal method to perform alone, unsupervised, as the post suggested.
“Don’t do anything before calling 911. In particular, don’t take an aspirin, then wait for it to relieve your pain. Don’t postpone calling 911. Aspirin won’t treat your heart attack by itself.
After you call 911, the 911 operator may recommend that you take an aspirin. He or she can make sure that you don’t have an allergy to aspirin or a condition that makes using it too risky. If the 911 operator doesn’t talk to you about taking an aspirin, the emergency medical technicians or the physician in the Emergency Department will give you an aspirin if it’s right for you.”
Likewise, Resuscitation Council U.K. states that “The correct advice for anyone who thinks they may be having a heart attack is to call immediately for an emergency ambulance and, whilst waiting for the ambulance to arrive, follow advice from the ambulance call handler”.