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Survival During Cardiac Arrest May Depend on Noisy Breathing

What About Angina? 

Angina pectoris occurs when the heart muscle, or myocardium, does not receive enough blood and oxygen needed for a given level of work. This is also referred to as ischemia. Although each individual may experience symptoms differently, the following are the most common symptoms of angina:.

  • a pressing, squeezing, or crushing pain - usually in the chest under the breast bone, but may also occur in the upper back, both arms, neck, or ear lobes. 
  • pain radiating in the arms, shoulders, jaw, neck, and/or back
  • shortness of breath
  • weakness and/or fatigue

People with angina tend to have an increased risk of heart attack. However, an episode of angina does not indicate that a heart attack is occurring, or that a heart attack is about to occur. Angina does indicate that coronary heart disease is present and that some part of the heart is not receiving an adequate blood supply.

A person who has angina should note the patterns of his/her symptoms - what causes the chest pain, what it feels like, how long episodes usually last, and whether medication relieves the pain. Be sure to call for medical assistance if the angina episode symptoms change sharply. 

Diagnosing angina pectoris may include a complete medical history and medical examination. A  physician can often diagnose angina pectoris by noting the patient's symptoms and how/when they occur. Certain diagnostic procedures may also determine the severity of the coronary heart disease, and may include: 

  • electrocardiogram (EKG) -  test that records the electrical activity of the heart, shows muscle damage, and abnormal rhythms 
  • stress test (treadmill or exercise EKG) - may be used to detect coronary artery disease
  • cardiac catheterization -procedure used to visualize abnormalities of specific arteries     

Specific treatment for angina pectoris will be determined by the physician based on factors such as your age, overall health, and medical history. Your opinion and treatment preferences are also taken into consideration, as well as your expectations for the course of the disease.

Medications may be prescribed for people with angina. The most common is nitroglycerin which helps to relieve pain by widening the blood vessels which allows more blood flow to the heart muscle and decreases the workload of the heart.

The underlying coronary artery disease that causes angina should be treated by controlling existing risk factors: high blood pressure, cigarette smoking, high blood cholesterol levels, high saturated fat diet, lack of exercise, and excess weight.

The symptoms of angina pectoris may resemble other medical conditions or problems.

Always consult your physician for more information.

[November 2008] A connection between noisy breathing and increased survival rates when someone is suffering sudden cardiac arrest has been made by researchers.  

Picture of female heart attack victim clinching her chest

When it comes to cardiac arrest, making a raucous noise that prompts swift medical attention may lead to better survival odds according to a recent study.

Dr. Vinay Nadkarni,  associate professor of anesthesia and critical care medicine at the University of Pennsylvania and spokesperson for the American Heart Association says, "More and more people now are willing to do CPR [cardiopulmonary resuscitation]. But there is information that they might not be starting it soon enough. An abnormal, gasping breathing pattern is consistent with cardiac arrest and calls for immediate action". 

Interpreting the Noise 

Gasping is a sign that there is still blood flow to the brain and the person can be saved even though the heart has stopped, says Dr.Nadkarni. "The big message to the lay public is that you can make a difference and save a life. If they can recognize this breathing pattern as abnormal, all they have to do is call 911 and push hard on the chest," Dr. Nadkarni notes. 

The American Heart Association  describes abnormal breathing as agonal, or sounds such as snoring, snorting, gurgling, moaning, or noisy breathing. In some cases, the person may appear to be barely breathing, but could also have labored, heavy breathing as an indication of distress.   

Gaspers versus Non-Gaspers

A  study of 1,218 reported cases in Phoenix, Arizona showed better survival rates when abnormal breathing such as gasping, gurgling, and moaning were noted during sudden cardiac arrest. Dr. Gordon A. Ewy, chief of cardiology at the University of Arizona, reported these findings in the medical journal Circulation.

The Arizona study found gasping in 39 percent of  of sudden cardiac arrest cases. Of that percentage, bystanders performed emergency cardiac measures, such as CPR, to both gaspers and non-gaspers about 40 percent of the time. Among those who received emergency help, 39 percent of the gaspers survived, compared to only 9.4 percent of the non-gaspers.      

The study further revealed, for those who did not get bystander help, survival rate was 21.1 percent for gaspers and 6.7 percent for non-gaspers.

In general, action can help even if no abnormal breathing is evident, according to Dr. Ewy. "If you start early enough and do a good job, some of these people will start gasping."   

Swift Emergency Action is Critical

The survival rates may be bolstered by nosier breathing, but calling 911 for emergency medical help and starting chest compressions without delay is critical. Many bystanders do not recognize abnormal breathing as a danger sign, says Dr. Ewy. "They call 911 and say that someone has fainted. When they are asked, are they breathing, they say, Oh yeah, they are breathing, so no one is dispatched."

Dr. Ewy continues, "Four or five minutes later, the person stops breathing and they call 911 again. That four or five minutes probably cost the patient his life."

Dr. Ewy says one problem may be the difficulty in finding a specific word or term that describes the abnormal breathing pattern. Case in point: "The most common description is snoring. A wife will say, my husband was snoring at night, and she woke up to find him dead."   

Immediate bystander action is vital and can be the difference between life or death, Dr. Ewy says. The results of the study illustrate the odds of gasping - and of survival - decreased steadily the later that emergency medical service was administered.

Always consult your physician for more information.

  
 
Yale School of Medicine