Life-threatening arrhythmias stopped by cough

In the course of 131 coronary angiographies, a non-ionic hyperosmolar contrast medium (Uromiro 75%, Bracco, Milano) provoked transient arrhythmias in 92 cases: 50 marked sinus bradycardias, 11 asystoles, 21 low-rate idiojunctional rhythms, 1 first-degree AV block, 7 third-degree AV blocks and 2 ventricular fibrillations. In 90 cases the rhythm disturbance was stopped by mere repeated cough. In the 2 cases of ventricular fibrillation direct current shock was used. If instructed coughing started within 8 seconds after the onset of arrhythmia, the patient maintained consciousness and the cough, as an internal cardiac massage, proved to be an adequate resuscitation method. In case prodromal signs of artificial bradycardiac arrhythmias were present, immediate cough could usually prevent the loss of consciousness and could also stop the arrhythmia. Therefore it seems logical to apply this method in patients at risk of Adams-Stokes attacks. A certain number of sudden deaths could be avoided.