Reader: I would like your opinion of some advice circulating on the Internet about what to do if you are driving alone and start experiencing severe chest pain about five miles from the nearest hospital. The article goes on to say that victims can help themselves by coughing repeatedly and very vigorously until they get to the hospital. To me, it seems stupid and hazardous for a person to keep driving when having a heart attack. I don't know about the coughing, but who would remember to cough in that situation?

Dr. Zipes: Your letter is challenging, and the first part may not have a "correct" answer.

A prime consideration during a heart attack is that "time equals heart muscle." By that I mean, the quicker a patient reaches professional help that may open up the clogged coronary artery and prevent further progression of the heart at tack, the less the heart, damage and the better the outcome. So, getting to the hospital quickly is paramount. I tell all my patients not to waste time calling me if they are having chest pain, but to call 911 and get to the nearest emergency room as quickly as possible.

Whether to keep on driving depends on your individual situation. If you were all alone with no chance of help between you and the hospital, it might be better to keep on driving. My "gut" response is, if you were no further than five or ten minutes to the hospital, drive through but call 911 on your cell phone and tell them what is happening. To stop for help may delay the arrival time at the hospital and reversal of the heart attack. The risk is, if you have a cardiac arrest en route, you could have a car accident with injury to you and others and not be at a place where immediate resuscitation can be performed. But who can predict that? So, you could reason that if you were more than 10 or 15 minutes away from the hospital because of traffic or distance, and were near houses or stores or (even better) if you knew a particular locale had an automated external defibrillator, it might be best to pull off and get help. Similarly, if the emergency response team was only a couple of minutes away, calling for help would be reasonable.

The second part of your question has an easier answer. Cardiac arrest can be caused by your heart going too slowly or too rapidly. The latter is more common than the former. Coughing can help keep the blood flowing to your brain during a slow heartbeat for a limited time and, thus, may help prevent a blackout. However, it is not likely to maintain circulation during the fast heartbeat (ventricular fibrillation) and therefore probably will not be helpful. Nevertheless, it would be a reasonable thing to try if you felt you were blacking out, but it is certainly not a reason to decide whether to keep driving to the hospital.