For heart attack, learn CPR rather than asking patient to cough

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DEAR DR. ROACH: There is a story going around the internet again that deep coughing after experiencing heart attack symptoms appears to keep the heart going while seeking help. Is there anything at all to that theory? It is being read by millions. — M.J.

ANSWER: There is something to the story, but it will only very rarely be of help to a bystander in the field.

I first became aware of this as a medical student, when I saw a resident physician, Dr. Mike O’Connor, rushing a patient on a gurney to the operating room and periodically (every second or two) telling the patient to cough. Eventually I was able to ask him about it, and he told me that a forceful cough can give enough blood flow to the brain that even if the heart isn’t pumping normally, a person can stay conscious long enough to get to definitive help. That blood flow prevents the damage that can happen to the brain within minutes if the heart stops entirely.

Unfortunately, this knowledge isn’t likely to be of help outside the hospital. More often than not, for the vast majority of the time that someone having a heart attack would need to keep the heart going, a person isn’t conscious and cannot cough; people whose heart is beating enough to stay conscious don’t need to cough. If you are having symptoms of a heart attack, your best bet is to call 911. If you find an unresponsive person, call 911 and start CPR if you are trained to do so. If you aren’t trained, get trained. It’s not hard to learn, and you might save a life.

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READERS: The booklet on heart attacks, America’s No. 1 killer, explains what happens, how they are treated and how they are avoided. Readers can order a copy by writing:

Dr. Roach

Book No. 102

628 Virginia Dr.

Orlando, FL 32803

Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: I had an ablation procedure for atrial fibrillation. Can a person drink alcohol after an ablation procedure? — V.

ANSWER: Electrical ablation is a potentially curative treatment for atrial fibrillation, an abnormal irregular heart rhythm. There are many risk factors for atrial fibrillation, but alcohol use, especially heavy alcohol use, is clearly one risk factor. I did find a study that showed that all drinkers are more likely to have poor outcome with ablation than nondrinkers. For people who have had a successful ablation, I would recommend against regular alcohol use; however, a rare drink is unlikely to be a major risk for going back into atrial fibrillation.

DEAR DR. ROACH: If the treatment for shingles is acyclovir, and you are on a herpes-suppression regimen and take acyclovir every day, can you still get shingles? Or will the antiviral in your system protect you from it? — K.M.B.

ANSWER: I can’t find a definitive answer for that. My guess is that the acyclovir, taken to prevent genital herpes (HSV-2), would reduce the risk of developing shingles but not eliminate it entirely. The dose of acyclovir for suppression of herpes is lower than the treatment dose for shingles, so it’s possible that the shingles still might develop.

As I mentioned in a previous column, people taking acyclovir (or other antiviral, such as valacyclovir (Valtrex) for HSV, need to be off the medicine (at least 24 hours before and two weeks after vaccination) in order for the shingles vaccine to work properly.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.

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