Cough-facilitated conversion of ventricular tachycardia

Area of Science:

• Cardiology
• Neurology

Background:

• Intracoronary injections of contrast medium can cause bradycardia and hypotension.
• Ventricular fibrillation and asystole can lead to loss of consciousness.
• Ventricular tachycardia is a potentially fatal cardiac arrhythmia.

Observation:

• A patient with ischemic heart disease experienced 33 episodes of drug-refractory ventricular tachycardia.
• Abrupt, forceful coughs performed on command successfully converted the tachycardia to normal sinus rhythm.
• When the patient could not cough, external electric countershock was required to restore normal sinus rhythm.

Findings:

• Coughing can be an effective method for terminating ventricular tachycardia in specific clinical scenarios.
• The Valsalva maneuver, induced by coughing, may play a role in arrhythmia conversion.
• This suggests a non-pharmacological, non-electrical intervention for managing certain tachyarrhythmias.

Implications:

• Cough cardiopulmonary resuscitation (CPR) may be a viable option for patients with recurrent ventricular arrhythmias.
• This technique could potentially be used in emergency settings to manage life-threatening arrhythmias.
• Further research is warranted to explore the efficacy and mechanisms of cough-induced arrhythmia conversion.