What's the best way to survive a heart attack if you're alone when it strikes? One persistent rumor claims you can increase your chances of survival by coughing "repeatedly and very vigorously" in a practice researchers call "cough CPR".
The text in the post (archived) reads:
HOW TO SURVIVE A HEART ATTACK WHEN ALONE?
This comes from Dr. Patrick Teefy, Cardiology Head at the Nuclear Medicine Institute University Hospital, London Ont.1. Let's say it's 7:25 pm and you're going home (alone of course) after an unusually hard day on the job.
2. You're really tired, upset and frustrated.
3. Suddenly you start experiencing severe pain in your chest that starts to drag out into your arm and up into your jaw. You are only about five km from the hospital nearest your home.
4. Unfortunately you don't know if you'll be able to make it that far.
5. You have been trained in CPR, but the guy that taught the course did not tell you how to perform it on yourself.
6. Since many people are alone when they suffer a heart attack without help, the person whose heart is beating improperly and who begins to feel faint, has only about 10 seconds left before losing consciousness.
7. However, these 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. A breath and a cough must be repeated about every two seconds without let-up until help arrives, or until the heart is felt to be beating normally again.
8. 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 to regain a normal rhythm. In this way, heart attack victims can get help or to a hospital
The doctor mentioned in the above example of the claim has since said online he does not endorse the practice of cough CPR.
Though early research on cough CPR found it could be helpful to some patients in some settings, more recent reviews of the technique found that while it could work, it should not be an alternative to traditional CPR. Some respected bodies on cardiac health like the British Heart Foundation and American Heart Association dismiss cough CPR entirely.
Variations of the claim that coughing during a heart attack can increase survival chances likely go back to a message circulating in June 1999 (seen in Snopes' prior reporting) and attributed to Rochester General Hospital and the Mended Hearts charity that supports heart patients and their family:
This one is serious … Let's say it's 4:17 p.m. and you're driving home, (alone of course) after an unusually hard day on the job. Not only was the work load extraordinarily heavy, you also had a disagreement with your boss, and no matter how hard you tried he just wouldn't see your side of the situation. You're really upset and the more you think about it the more up tight you become. All of a sudden 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.
HOW TO SURVIVE A HEART ATTACK WHEN ALONE
Since many people are alone when they suffer a heart attack, this article seemed 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, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest. A breath and a cough must be repeated about every two 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 phone and, between breaths, call for help.
Tell as many other people as possible about this, it could save their lives!
From Health Cares, Rochester General Hospital via Chapter 240's newsletter. AND THE BEAT GOES ON… (reprint from The Mended Hearts, Inc. publication, Heart Response)
Part of this text was also reproduced in the Jun. 22, 1999, edition of the Crowley Post-Signal, a newspaper in Louisiana, also attributed to Rochester General Hospital. The hospital and Mended Hearts have both denied that they wrote or endorsed this claim.
Method Could Work but Critics Say Studies Are Too Restrictive
While the claim about cough CPR goes back decades, newer research generally showed that if cough CPR works, it works in a limited number of cases for a limited number of people.
An early study on cough CPR from 1976 found that:
Cough-CPR, accomplished by abrupt, forceful coughing maintains consciousness by rhythmic compression of the heart, has several advantages over external CPR in the catheterization laboratory, and may be applicable to other situations where serious rhythm disturbances are recognized before unconsciousness occurs.
While this initial study included only a sample size of eight people, the lead author continued to publish favorably on the topic until 2006.
Another oft-cited study on cough CPR was carried out by Polish researchers in 1998. This study saw people with Stokes-Adams Syndrome — a disorder that causes fainting due to abnormal heart rhythm — learn to predict the onset of a fainting spell and use rhythmic coughing to stay conscious. The study concluded that: "evoked coughing can effectively prevent fainting and maintaining consciousness until conventional CPR help becomes available."
Critics of these studies say that the results have been achieved in hospital settings with supervised patients. The Resuscitation Council UK, a health care charity focused on resuscitation education, issued a statement on the claim in 2018, since reviewed in 2021, saying:
The incorrect "advice" has probably been based (very loosely) on a few published case reports of people with sudden cardiac arrest being able to maintain a heartbeat, and therefore a circulation, by repeated vigorous coughing - so-called "cough CPR". However, this has been achieved in hospitals, during tests or treatment on the heart in which the person was being monitored closely and supervised by doctors throughout.
Cardiac arrest usually causes loss of consciousness within a matter of seconds, giving a person no warning. Even if a person suspected that they were having a cardiac arrest, it is highly unlikely that coughing could maintain enough circulation to do anything else, let alone drive safely.
A British study from 2021 reviewed several resuscitation methods, including cough CPR, and found that "Cough CPR, percussion pacing and precordial thump should not be routinely used in established cardiac arrest." Percussion pacing and precordial thump are alternative CPR methods that consist of striking the chest with a closed fist or delivering a single sharp blow to the patient's chest, respectively.
The study further found that these alternative methods "must not delay standard CPR efforts in those who lose cardiac output."
This is echoed in advice from the British Heart Foundation, American Heart Association and respected medical institutions like the Cleveland Clinic. The most important thing, these groups say, is to call emergency services (911 in the U.S.) if you suspect you or someone else is having a heart attack.
Snopes' archives contributed to this report