May 2019 KC Health Flyer

May KC Health Flyer

May is National Stroke Awareness Month

In this month alone some 65,000 Americans will experience a stroke according to the National Stroke Association.

The national Institutes of Health report strokes are the fifth leading cause of death in the U.S.

You are likely aware of many of the risk factors of other diagnoses like heart disease or breast cancer, but what do you really know about stroke?

By Alicia Wanek: from Good Life Family Magazine, June 2019

When Don M. woke up one morning to start his day, he quickly realized something wasn’t quite right.  “I went to go make coffee and didn’t know what I was doing.  I just couldn’t make the coffee.  I told my wife we needed to go to the doctor.”  Fortunately, his wife sought medical attention immediately.  According to Dr. Harry Dorsey timeliness is of the essence.  “The primary symptoms of a stroke are slurred speech; unilateral weakness, meaning weakness on one side of the body or the other; and sudden facial droop.  If you notice any of these three things, it’s critical to get to an emergency room as quickly as possible because there’s a limited amount of time to be given an agent to dissolve the clot.”  

A stroke is caused when there’s a blockage or rupture of a blood vessel to the brain. Brain cells in the immediate area begin to die because they stop getting the oxygen and nutrients they need to function.  In the case of a stroke caused by a blockage, or an ischemic stroke, administration of tPA (tissue plasminogen activator) within approximately four hours can reverse the course of the stroke.  “Four hours is the gold standard,” says Dr. Dorsey, although he points to some studies showing there is some benefit of tPA administration within six hours.  In the case of a hemorrhagic stroke, however, the outcome is less favorable.  “If it’s a brain bleed, they can’t do as much about that,” he says.

Despite getting to the hospital quickly, Don’s recovery was still a long process.  After four days in the hospital he was moved to a rehabilitation facility for two weeks and then an additional six months of therapy at home.  The extent of a stroke can cause many long-lasting effects including speech and swallowing difficulties, unilateral weakness, memory issues, and trouble with visual-perceptive skills, among many others.

How can you prevent a stroke?  Of course, good lifestyle choices make the biggest impact.  Healthy, low cholesterol diets and exercise prevent arterial buildup.  The biggest risk factors according to Dr. Dorsey are smoking and hypertension, so eliminating all nicotine products and monitoring your blood pressure through regular checkups is imperative.  Having a family history of hypertension or strokes can put you at risk, too.  Since stroke can affect even those who appear very healthy, ultimately recognizing stroke symptoms and getting medical help immediately can be most important in preventing long-term impact.

For Don, seeking medical help when he first experienced symptoms likely saved his life, and for that he’s extremely grateful.  For his children and grandchildren, they are equally grateful to have had these six more years to create memories with their beloved “Papaw.”

The BE FAST symptoms

You may not see all the symptoms at the time of a stroke (also referred to as a brain attack). The key to noticing something’s amiss is the sudden onset of symptoms like these:

Balance – Sudden loss of balance

A stroke is caused by blood not flowing to portions of the brain. As parts of the brain shut down, muscle control and other senses are affected. Loss of balance could vary from that head-spinning feeling of just stepping off a merry-go-round to having one leg kicked out from a three-legged stool. Depending on when you encounter someone having a brain attack, they may be in the stage of feeling dizzy, grabbing at the air for something to steady themselves, or already crumpled in a heap.

Eyes – Sudden loss of vision in one or both eyes

While other diseases and injuries can cause a loss of vision, the key in a stroke is a sudden onset with no previous symptoms. Vision loss is a matter of degrees, your victim may not have total loss of vision but may be having blurred vision or double vision as a result of the brain attack.

Face – Looks uneven

A stroke may affect the nerves that control facial expressions. Frequently only one side of the face is affected and the result is an uneven look—a drooping of the eyes, mouth, and cheeks.

Arms – One arm is weak or numb

The same droopiness that affects the face can affect an arm or leg. It’s just a different set of nerves being affected by the brain attack. The arm weakness may be a matter of degree, ranging from numbness to flat out being unable to move or function.

Speech – Slurred or seeming confused

When the brain’s speech center is under attack the results are going to be confusion, problems enunciating words, incomplete thoughts, or bizarre and random associations. Other diseases or injuries can cause similar patterns, but the key to a brain attack is a sudden onset of these symptoms.

Time – Call 9-1-1 now

Brain attacks happen with all degrees of severity and there’s rarely a gold-standard where all the symptoms are in play and easily recognized. If you’re seeing any of the BE FAST signs with that underlying theme of suddenness, make the call.

What is fainting?

(From MedlinePlus)

Fainting happens when your brain does not get enough oxygen. You lose consciousness, or “pass out,” for a brief time (usually just a few seconds or minutes).

Symptoms of fainting

The primary symptom of fainting is losing consciousness. But there are other symptoms that may occur before you faint. These include feeling:

• lightheaded
• dizzy
• weak
• nauseated
• sweaty
• You also may have a headache or ringing in your ears.

What causes fainting?

Fainting, which is also called syncope, can be caused by many different things. Sometimes a specific cause for fainting cannot be found.

A sudden drop in your blood pressure can cause you to faint. Sometimes your heart rate and blood vessels can’t react fast enough when your body’s need for oxygen changes. This is very common among older people. It is also common in people who have certain health conditions, such as diabetes. Fainting can happen when:

• You stand up too fast.
• You work or play hard, especially if it’s very hot.
• You begin to breathe too fast (called hyperventilating).
• You get very upset. Being upset can affect the nerves that control your blood pressure.
• You’re taking medicine for high blood pressure.

Coughing, urinating, and stretching can also get in the way of the flow of oxygen to the brain and may cause you to faint. If you faint once during one of these activities, it’s probably not something to worry about. But if it happens more than once, tell your doctor about it.

If you faint when you turn your head to the side, the bones in your neck may be pinching one of the blood vessels that lead to your brain. If this happens to you, be sure to tell your doctor about it.

A drop in your blood sugar may also cause you to faint. This can happen if you have diabetes. It may also happen if you don’t eat for a long time.

Some prescription medicines can cause fainting. Be sure to talk to your doctor if you think your fainting may be related to a medicine you’re taking.

Alcohol, cocaine, and marijuana can also cause fainting.

More serious causes of fainting include seizures and problems with the heart or with the blood vessels leading to the brain.

How is fainting diagnosed?

Your doctor will probably ask you about what was happening or what you were doing when you fainted. He or she may ask you for details about how you felt right before and right after you fainted. Your doctor will probably also want to examine you and may perform some tests to find out why you fainted.

Can fainting be prevented or avoided?

People who have certain medical conditions are more likely to faint. These conditions include:

• heart problems such as an irregular heartbeat, or blockages in or near the heart that prevent the blood from getting to the brain
• diabetes
• anxiety or panic disorders
• dehydration
• low blood sugar.

What should I do if I think I’m going to faint?

If you feel like you’re going to faint, lie down. If you can’t lie down, sit and bend forward with your head between your knees. This helps get the blood flowing to your brain. Wait until you feel better before trying to stand up. When you stand up, do so slowly.

Fainting treatment

You probably don’t need to go to your doctor if you have only fainted one time and you are otherwise in good health. Fainting is common and usually not serious. However, if you have serious health problems, you probably should see your doctor. This is especially important if you have heart-related problems, high blood pressure, or diabetes. See your doctor if you faint and also have any of these symptoms or conditions:

• irregular heartbeat
• chest pain
• pregnancy
• shortness of breath
• sudden onset (no warning signs)
• blurred vision
• confusion
• trouble talking
• taking longer than a few seconds to regain consciousness
• fainting when you turn your head to the side
• fainting more than once in a month

Living with fainting

In most cases, fainting can be treated and controlled. Often, diagnosing what is causing fainting is the most difficult part. If your fainting is not under control, you should talk to your doctor about whether it is safe for you to drive.

Questions to ask your doctor

• What is the most likely cause of my fainting?
• Is there something I can do to stop my fainting spells?
• Is there a medicine I can take that will help prevent fainting?
• Are there any steps I can take at home that will help me stop fainting?
• If I faint once, should I call the doctor immediately after I wake up?
• Is there a diet I should follow to help deal with my fainting?
• Are there any websites you recommend that I access? Do you have any educational materials I could read about fainting?

Resources

National Institutes of Health: MedlinePlus: Fainting

What Is Fainting? (From WebMD)

Fainting, also called syncope (pronounced SIN-ko-pee), is a sudden, brief loss of consciousness and posture caused by decreased bloodflow to the brain.

Many different conditions can cause fainting. These include heartproblems such as irregular heart beats, seizures, low blood sugar(hypoglycemia), anemia (a deficiency in healthy oxygen carrying cells), and problems with how the nervous system regulates blood pressure. Some types of fainting seem to run in families.

While fainting may indicate a particular medical condition, sometimes it may occur in an otherwise healthy individual. Fainting is a particular problem for the elderly who may suffer serious injuries from falls when they faint. Most episodes are very brief. In most cases, the individual who has fainted regains complete consciousness within just a few minutes

What Makes You Faint? 

Fainting is a common problem, accounting for 3% of emergency room visits and 6% of hospital admissions. It can happen in otherwise healthy people. A person may feel faint and lightheaded (presyncope) or lose consciousness (syncope).

What Causes Fainting?

Fainting may have a variety of causes. A simple episode, also called a vasovagal attack or neurally-mediated syncope, is the most common type of fainting spell. It is most common in children and young adults. A vasovagal attack happens because blood pressure drops, reducing circulation to the brain and causing loss of consciousness. Typically an attack occurs while standing and is frequently preceded by a sensation of warmth, nausea, lightheadedness and visual “grayout.” If the syncope is prolonged, it can trigger a seizure.

You may suffer from a simple fainting spell due to anxiety, fear, pain, intense emotional stress, hunger, or use of alcohol or drugs. Most people who suffer from simple fainting have no underlying heart or neurological (nerve or brain) problem.

Some people have a problem with the way their body regulates their blood pressure, particularly when they move too quickly from a lying or sitting position to a standing position. This condition is called postural hypotension and may be severe enough to cause fainting. This type of fainting is more common in the elderly, people who recently had a lengthy illness that kept them in bed and people who have poor muscle tone.

The following can cause fainting, too:

Diseases of the autonomic nervous system. Your autonomic nervous system is the part of the nervous system that controls involuntary vital functions, such as the beating of your heart, the degree to which your blood vessels are constricted, and breathing. Autonomic nervous system problems include acute or subacute dysautonomia, chronic post-ganglionic autonomic insufficiency, and chronic pre-ganglionic autonomic insufficiency. If you have one of these disorders, you are likely to have other symptoms, such as erectile dysfunction (inability to have or maintain an erection), loss of bladder and bowel control, loss of the normal reflexes of your pupils, or decreased sweating, tearing, and salivation.

Conditions that interfere with the parts of the nervous systemthat regulate blood pressure and heart rate. These conditions include diabetes, alcoholism, malnutrition, and amyloidosis (in which waxy protein builds up in the tissues and organs). If you take certain high blood pressure drugs, which act on your blood vessels, you may be more likely to suffer from fainting. If you are dehydrated, which may affect the amount of blood in your body and, thus, your blood pressure, you may be more likely to faint.

Heart or blood vessel problems that interfere with blood flow to the brain. These may include heart block (a problem with the electrical impulses that control your heart muscle), problems with the sinus node (a specialized area of your heart that helps it beat), heart arrhythmia (irregular heart rhythm), a blood clot in the lungs, an abnormally narrowed aortic heart valve, or certain other problems with the structure of your heart.

Conditions that may cause unusual patterns of stimulation to particular nerves. These include micturition syncope (fainting during or after urination), glossopharyngeal neuralgia (fainting due to inflammation and pain in a particular nerve to the mouth); cough syncope (fainting after intense coughing), and stretch syncope (fainting that occurs when stretching the neck and arms).

Hyperventilation. If you become intensely anxious or panicked and breathe too quickly, you may feel faint from hyperventilation (taking in too much oxygen and getting rid of too much carbon dioxide too quickly).

WebMD Medical Reference Reviewed by Carol DerSarkissian on April 25, 2019

What Makes You Faint

1/1 6

You’re Dehydrated

Dehydration can happen if you don’t drink enough or you lose too much fluid. Then your blood pressure drops and your nervous system can’t control it well, which could make you faint. That’s why it’s a good idea to get plenty of water, especially when it’s hot outside. If your pee isn’t clear, you may need a bit more to drink.

2/16

Arrhythmia

It means your heart has an irregular beat. That sometimes slows the flow and amount of blood that gets to your brain, which can make you pass out. It may be the first or only obvious symptom of the problem. See your doctor right away if you suspect arrhythmia because it could be a sign of a serious heart problem that needs treatment. 

3/16

Cyanotic Breath-Holding

It happens mostly in kids between ages 6 months and 5 years. They cry hard enough to cut off oxygen and trigger an automatic response that makes them faint. They may turn blue, pass out for about a minute, and seem groggy afterward. They don’t do it on purpose. It’s a reflex they can’t control. Though it’s scary to see at first, it’s nothing to worry about and might even happen repeatedly.  

4/16

Pallid Breath-Holding

This one also happens mainly in young kids. A sudden fright or pain causes the heart to stop for a few seconds. With no sound, a child might open his mouth before turning very pale and passing out for about a minute. Pallid breath-holding sometimes happens after your child gets hurt. It’s not the injury itself that causes this automatic response, but the shock of it. It should go away by age 5.

5/16

Low Blood Sugar

The medical term is hypoglycemia. It may make you dizzy, shaky, tired, confused, and blur your vision. You can usually fix the problem if you get a few grams of carbs from juice or candy. Otherwise, you could pass out. If that happens, you need medicine called glucagon to help your body release more sugar.

6/16

Diabetes

High blood sugar from diabetes can damage the nerves in your body that help keep your blood pressure steady. That could lead to unusually low blood pressure that makes you pass  

7/16

Medicine

Some medications, like high blood pressure drugs and antidepressants, affect the way your heart and blood vessels act when you stand. This can drop your blood pressure and make you pass out. Insulin used to lower blood sugar when you have diabetes might cause hypoglycemia that also leads to fainting. In older people, different drugs sometimes combine with illness and the situation you’re in — like standing in a hot room —  to make you faint.

8/16

Seizure

It’s a sudden change in the brain’s normal electrical signals. Some symptoms, like eyes rolling back and jerking movements, may be similar to breath-holding. The difference is seizures make you unconscious for minutes, not seconds, and might make you lose control of your bladder. And you could see flashes of light or get unusual smells or tastes with no obvious source. See your doctor if you suspect a seizure. 

9/16

Standing Up

If you faint when you rise, you could have a condition called postural orthostatic tachycardia syndrome (POTS). It increases your pulse too much when you stand or sit up. You might feel sick, dizzy, shaky, or sweaty, and your heart may skip a beat. And you could pass out. It can help to drink plenty of fluids, limit caffeine and alcohol, and try to get up more slowly. Your doctor may suggest medicine to treat it.

10/16

Heart Problems

Damaged heart muscle, blocked or narrowed blood vessels (coronary heart disease), and other kinds of ticker trouble can stop enough blood loaded with oxygen from getting to your brain. When it makes you pass out, it’s called cardiac syncope. It may happen without warning, sometimes repeatedly over a period of weeks. See your doctor right away if you suspect this or also have chest pain, arrhythmia, fatigue, or other symptoms.

11/16

Shock

 The technical term for this is vasovagal syncope. Your body overreacts to the sight of blood, sudden intense emotion, fear of injury, or something else that jars you. Your heart rate slows as blood vessels widen and blood pools in your legs, away from your brain. You may be cold, clammy, pale, and nauseated right before it happens. If you feel like you might faint, lie down and raise your legs.

12/16

Hyperventilation

You feel like you can’t get enough air, so you start to breathe in more quickly. Though it’s unclear why, this makes blood vessels around your brain shrink, which limits oxygen and makes you lightheaded and possibly faint. Fear, rather than a physical problem, usually causes it, though you can bring it on if you hold your breath. Your hands, feet, and mouth might also tingle.

13/16

Coughing

Especially if it’s deep and you can’t stop, it might prevent your blood from getting enough oxygen, which could make you faint. It’s more common in babies with pertussis, but it can happen to anyone. Asthma, which makes it harder to breathe, may have the same effect. Get to a hospital right away if you have a serious asthma attack or pass out from coughing.

14/16

Drinking Alcohol

It causes your blood vessels to expand, which can lead to a drop in your blood pressure. You can pass out when you drink so much that you reach a dangerously high blood alcohol concentration.

15/16

Your Collar’s Too Tight

Carotid sinus syncope, or “tight-collar syndrome,” happens when something pushes on nerves at a wide part of your carotid artery in your neck. This interferes with blood flow to the brain and makes you faint. It happens quickly and without other symptoms like nausea, paleness, and sweating. In some cases, if it hasn’t happened before, it may be a sign of narrowed arteries that need treatment.

Nope, I don’t know what 16/16 is. I looked for it, but the article just went into What Heat can do to you.

2015 HANDS-ONLY CPR FACT SHEET

WHY LEARN HANDS-ONLY CPR?

Cardiac arrest – an electrical malfunction in the heart that causes an irregular heartbeat (arrhythmia) and disrupts the flow of blood to the brain, lungs and other organs – is a leading cause of death. Each year, over 326,000 out-of-hospital cardiac arrests occur in the United States.

When a person has a cardiac arrest, survival depends on immediately getting CPR from someone nearby.

According to the American Heart Association, 90 percent of people who suffer out-of-hospital cardiac arrests die. CPR, especially if performed immediately, can double or triple a cardiac arrest victim’s chance of survival.

Most Americans (70 percent) feel helpless to act during a cardiac emergency because they don’t know how to administer CPR or they’re afraid of hurting the victim.

BE THE DIFFERENCE FOR SOMEONE YOU LOVE

If you are called on to give CPR in an emergency, you will most likely be trying to save the life of someone you love: a child, a spouse, a parent or a friend.

70 percent of out-of-hospital cardiac arrests happen in homes and residential settings.

Unfortunately, only about 39% of people who experience an out-of-hospital cardiac arrest get the immediate help that they need before professional help arrives.

Hands-Only CPR has been shown to be as effective as conventional CPR for cardiac arrest at home, at work or in public. It can double or even triple a victim’s chance of survival. 

MUSIC CAN SAVE LIVES 

Hands-Only CPR has just two easy steps: If you see a teen or adult suddenly collapse, (1) Call 9-1-1; and (2) Push hard and fast in the center of the chest to the beat of the disco song “Stayin’ Alive.”

People feel more confident performing Hands-Only CPR and are more likely to remember the correct rate when trained to the beat of a familiar song.

During CPR, you should push on the chest at a rate of at least 100 compressions per minute. The beat of “Stayin’ Alive” is a perfect match for this. 

TAKE A MINUTE TO LEARN HOW TO SAVE A LIFE Watch the short demo video. Visit org/handsonlycpr to watch the Hands-Only CPR instructional video and share it with the important people in your life. You can also find a CPR class near you.

How to Survive a Heart Attack When Alone

Rhythmically coughing during a heart attack may increase your chances of surviving it, but self-undertaking that procedure can be problematic.

SNOPES STAFF

PUBLISHED 30 JUNE 1999

Claim  Rhythmically coughing during a heart attack increases your chances of surviving it.

 Origin

This supposedly helpful narrative about surviving heart attacks began its life on the Internet in June 1999:

From my sister, the surgical nurse and certified CPR teacher:

Please pause for 2 minutes and read this:

1. Let’s say it’s 7.25pm 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 in to 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 who taught the course did not tell you how to perform it on yourself.
6. HOW TO SURVIVE A HEART ATTACK WHEN ALONE? 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 regain normal rhythm. In this way, heart attack victims can get to a hospital.
9. Tell as many other people as possible about this. It could save their lives!!
10. A cardiologist says If everyone who gets this mail kindly sends it to 10 people, you can bet that we’ll save at least one life.
11. Rather than sending jokes, please… contribute by forwarding this mail which can save a person’s life.
12. If this message comes around you… more than once… please don’t get irritated… You should instead, be happy that you have many friends who care about you & keeps reminding you how to deal with a Heart attack.

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)

Those kindhearted souls who started it on its way likely had no inkling the advice they were forwarding could potentially be harmful to someone undergoing a heart attack, but that is indeed the case.

 Even were the afflicted to correctly recognize they were experiencing the sort of cardiac event where cough CPR could help, without specific training to hit the right rhythms their coughing could turn mild heart attacks into fatal ones.

 Yet even if cough CPR can be effectively taught by physicians, it’s not going to be learned from an e-mail, at least not well enough to be safe.   ……there’s a wide (and dangerous) gap between in-person one-on-one training by a professional on hand to quickly correct a patient’s mistakes before they become habit and generic printed instruction wholly lacking in direct feedback and guidance. Thinking one is a valid substitute for the other would be akin to believing studying a typed set of instructions is all it takes to learn how to drive a car well enough to take it down the freeway and back.

The e-mailed advice about coughing during a heart attack leaves the impression the “cough CPR” technique is endorsed by Rochester General Hospital and Mended Hearts. Rochester General had nothing to do with any of this — how its name came to be attached to this message is a mystery.  

Although the text of the e-mailed advice was published in a newsletter put out by Mended Hearts (a support group for heart disease patients and their families), that organization has since disavowed it and has a page on its web site asking readers not to heed the advisory. The piece on cough CPR found its way into that publication through a blend of too much enthusiasm and a dearth of fact checking. From there, other chapters picked it up, spreading the notion to an even wider audience. Attempts now to distance the organization from it don’t begin to undo the damage done by the piece having been picked up from there.

Darla Bonham, Mended Heart’s executive director, has since issued a statement about cough CPR:

I’ve received email from people all across the country wanting to know if it is a valid medically approved procedure. I contacted a scientist on staff with the American Heart Association Emergency Cardiac Care division, and he was able to track a possible source of the information. The information comes from a professional textbook on emergency cardiac care. This procedure is also known as “cough CPR” and is used in emergency situations by professional staff. The American Heart Association does not recommend that the public use this method in a situation where there is no medical supervision.

Dr. Richard O. Cummins, Seattle’s director of emergency cardiac care, explains that cough CPR raises the pressure in the chest just enough to maintain some circulation of oxygen-containing blood and help enough get to the brain to maintain consciousness for a prolonged period. But cough CPR should be used only by a person about to lose consciousness, an indication of cardiac arrest, he cautions. It can be dangerous for someone having a heart attack that does not result in cardiac arrest. Such a person should call for help and then sit quietly until help arrives, he says.

In other words, the procedure might be the right thing to attempt or it might be the very thing that would kill the afflicted depending on which sort of cardiac crisis is being experienced. Without a doctor there to judge the situation and, if cough CPR is indicated, to supervise the rhythmic coughing, the procedure is just far too risky for a layman to attempt.

Forget about coughing — key to surviving a heart attack is obtaining proper medical assistance within a very limited window of opportunity. Once an acute myocardial infarction (AMI) has been diagnosed, speedy injection of thrombolytic agents to dissolve clots is of the utmost importance — the more quickly those drugs are delivered, the better the chances of survival are. It’s a race against the clock.

Most patients who present with minor chest pains usually look healthy and show no signs of a heart attack.

Electrocardiogram (ECG) results tell the story though, so be sure to insist upon one being performed if you’ve any doubts at all. Often mild heart attacks are left untreated and undetected because hospital staff mistake a heart attack for something more benign because the presenting symptoms are minor.

Rather than risk killing yourself with cough CPR, those experiencing a heart attack should heed the advice of physicians the world over — down a couple of Aspirin as an emergency remedy. Doctors believe that during the early stages of a heart attack, Aspirin — which is known to prevent blood platelets from sticking together — can prevent a clot from getting bigger. In 1991 Dr. Michael Vance, president of the American Board of Emergency Medicine, recommended that people who think they are having a heart attack should “Call 911, then take an Aspirin.”

Oh, and it probably makes a great deal of sense to chew the Aspirin before swallowing. The sooner it is dispersed by the stomach, the sooner it gets to where it is needed. During a heart attack, waiting for the enteric coating surrounding the pill to break down naturally could be a mistake.

In 1993 The American Heart Association began recommending a 325 mg Aspirin at the onset of chest pain or other symptoms of a severe heart attack. That bit of advice is going unheeded, though; a follow-up report published in 1997 shows as many as 10,000 American lives a year could be saved if more people who think they’re having a heart attack took an aspirin at the start of chest pains.

In terms of the drama of it, swallowing an Aspirin seems quite a come-down from bravely trying to induce a perfectly timed coughing fit. Less flamboyant is better, though; Aspirin saves lives, whereas coughing might well cost them.

PUBLISHED 30 JUNE 1999

BY    SNOPES STAFF